Drug treatments for covid-19: living systematic review and network meta-analysis

BMJ, Journal Year: 2020, Volume and Issue: unknown, P. m2980 - m2980

Published: July 30, 2020

To compare the effects of treatments for coronavirus disease 2019 (covid-19). Living systematic review and network meta-analysis. WHO covid-19 database, a comprehensive multilingual source global literature, up to 3 December 2021 six additional Chinese databases 20 February 2021. Studies identified as 1 were included in analysis. Randomised clinical trials which people with suspected, probable, or confirmed randomised drug treatment standard care placebo. Pairs reviewers independently screened potentially eligible articles. After duplicate data abstraction, bayesian meta-analysis was conducted. Risk bias studies assessed using modification Cochrane risk 2.0 tool, certainty evidence grading recommendations assessment, development, evaluation (GRADE) approach. For each outcome, interventions classified groups from most least beneficial harmful following GRADE guidance. 463 enrolling 166 581 patients included; 267 (57.7%) 89 814 (53.9%) are new previous iteration; 265 (57.2%) evaluating at 100 events met threshold inclusion analyses. Compared care, three drugs reduced mortality mostly severe moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 7 fewer, certainty), interleukin-6 receptor antagonists when given (23 1000, 36 Janus kinase inhibitors (44 64 high certainty). two probably reduce hospital admission non-severe disease: nirmatrelvir/ritonavir (36 41 26 certainty) molnupiravir (19 29 5 Remdesivir may (29 6 low Only had quality reduction time symptom resolution (3.3 days 4.8 1.6 certainty); several others showed possible benefit. Several increase adverse leading discontinuation; hydroxychloroquine increases mechanical ventilation (moderate Corticosteroids, antagonists, confer other important benefits covid-19. Molnupiravir This not registered. The protocol is publicly available supplementary material. article living that will be updated reflect emerging evidence. Updates occur years date original publication. fifth version published on 30 July 2020 (BMJ 2020;370:m2980), versions can found supplements. When citing this paper please consider adding number access clarity.

Language: Английский

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Probiotic improves symptomatic and viral clearance in Covid19 outpatients: a randomized, quadruple-blinded, placebo-controlled trial

Gut Microbes, Journal Year: 2022, Volume and Issue: 14(1)

Published: Jan. 11, 2022

Intestinal bacteria may influence lung homeostasis via the gut-lung axis. We conducted a single-center, quadruple-blinded, randomized trial in adult symptomatic Coronavirus Disease 2019 (Covid19) outpatients. Subjects were allocated 1:1 to probiotic formula (strains Lactiplantibacillus plantarum KABP022, KABP023, and KAPB033, plus strain Pediococcus acidilactici KABP021, totaling 2 × 109 colony-forming units (CFU)) or placebo, for 30 days. Co-primary endpoints included: i) proportion of patients complete viral remission; ii) progressing moderate severe disease with hospitalization, death; iii) days on Intensive Care Unit (ICU). Three hundred subjects (median age 37.0 years [range 18 60], 161 [53.7%] women, 126 [42.0%] having known metabolic risk factors), 293 completed study (97.7%). Complete remission was achieved by 78 147 (53.1%) group compared 41 146 (28.1%) placebo (RR: 1.89 [95 CI 1.40-2.55]; P < .001), significant after multiplicity correction. No hospitalizations deaths occurred during study, precluding assessment remaining co-primary outcomes. Probiotic supplementation well-tolerated reduced nasopharyngeal load, infiltrates duration both digestive non-digestive symptoms, placebo. compositional changes detected fecal microbiota between but significantly increased specific IgM IgG against Severe Acute Respiratory Syndrome (SARS-CoV2) It is thus hypothesized this primarily acts interacting host's immune system rather than changing colonic composition. Future studies should replicate these findings elucidate its mechanism action (Registration: NCT04517422).Abbreviations: AE: Adverse Event; BMI: Body Mass Index; CONSORT: CONsolidated Standards Reporting Trials; CFU: Colony-Forming Units; eDRF: Electronic Daily Report Form; GLA: Gut-Lung Axis; GSRS: Gastrointestinal Symptoms Rating Scale; hsCRP: High-sensitivity C-Reactive Protein; HR: Hazard Ratio; ICU: Unit; OR: Odds PCoA: Principal Coordinate Analysis; RR: Relative Risk; RT-qPCR: Real-Time Quantitative Polymerase Chain Reaction; SARS-CoV2: acute respiratory syndrome coronavirus 2; SpO2: Peripheral Oxygen Saturation; WHO: World Health Organization.

Language: Английский

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Therapeutic advances in COVID-19

Nature Reviews Nephrology, Journal Year: 2022, Volume and Issue: 19(1), P. 38 - 52

Published: Oct. 17, 2022

Language: Английский

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Vitamin C in the Treatment of COVID-19

Nutrients, Journal Year: 2021, Volume and Issue: 13(4), P. 1172 - 1172

Published: April 1, 2021

Vitamin C is an essential nutrient that serves as antioxidant and plays a major role co-factor modulator of various pathways the immune system. Its therapeutic effect during infections has been matter debate, with conflicting results in studies respiratory critically ill patients. This comprehensive review aimed to summarize current evidence regarding use vitamin prevention or treatment patients SARS-CoV2 infection, based on available publications between January 2020 February 2021. Overall, 21 were included this review, consisting case-reports case-series, observational studies, some clinical trials. In many publications, data incomplete, most trials are still pending. No COVID-19 supplementation found. Although observations reported improved medical condition treated C, from controlled scarce inconclusive. Based theoretical background presented article, preliminary encouraging SARS-CoV-2 infection should be further investigated.

Language: Английский

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Nutrition in the Actual COVID-19 Pandemic. A Narrative Review

Nutrients, Journal Year: 2021, Volume and Issue: 13(6), P. 1924 - 1924

Published: June 3, 2021

The pandemic of Coronavirus Disease 2019 (COVID-19) has shocked world health authorities generating a global crisis. present study discusses the main finding in nutrition sciences associated with COVID-19 literature. We conducted consensus critical review using primary sources, scientific articles, and secondary bibliographic indexes, databases, web pages. method was narrative literature available regarding interventions nutrition-related factors during pandemic. search engines used research were PubMed, SciELO, Google Scholar. found how lockdown promoted unhealthy dietary changes increases body weight population, showing obesity low physical activity levels as increased risk affection physiopathology. In addition, hospitalized patients presented malnutrition deficiencies vitamin C, D, B12 selenium, iron, omega-3, medium long-chain fatty acids highlighting potential effect C D interventions. Further investigations are needed to show complete role implications both prevention treatment COVID-19.

Language: Английский

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Antioxidant, anti-inflammatory and immunomodulatory roles of vitamins in COVID-19 therapy

European Journal of Medicinal Chemistry, Journal Year: 2022, Volume and Issue: 232, P. 114175 - 114175

Published: Feb. 4, 2022

Language: Английский

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Nutrition, Immunosenescence, and Infectious Disease: An Overview of the Scientific Evidence on Micronutrients and on Modulation of the Gut Microbiota

Advances in Nutrition, Journal Year: 2022, Volume and Issue: 13(5), P. S1 - S26

Published: May 6, 2022

The immune system is key to host defense against pathogenic organisms. Aging associated with changes in the system, a decline protective components (immunosenescence), increasing susceptibility infectious disease, and chronic elevation low-grade inflammation (inflammaging), risk of multiple noncommunicable diseases. Nutrition determinant cell function gut microbiota. In turn, microbiota shapes controls inflammatory responses. Many older people show Age-related competence, inflammation, dysbiosis may be interlinked relate, at least part, age-related nutrition. A number micronutrients (vitamins C, D, E zinc selenium) play roles supporting many types. Some trials report that providing these as individual supplements can reverse deficits and/or those insufficient intakes. There inconsistent evidence this will reduce or severity infections including respiratory infections. Probiotic, prebiotic, synbiotic strategies modulate microbiota, especially by promoting colonization lactobacilli bifidobacteria, have been demonstrated some biomarkers and, cases, gastrointestinal infections, although, again, inconsistent. Further research well-designed well-powered at-risk populations required more certain about role modify microbiota-host relationship protecting infection, infection.

Language: Английский

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Prophylaxis against covid-19: living systematic review and network meta-analysis

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n949 - n949

Published: April 26, 2021

Abstract Updates This is the second version (first update) of living systematic review, replacing previous (available as a data supplement). When citing this paper please consider adding number and date access for clarity. Objective To determine compare effects drug prophylaxis on severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection disease 2019 (covid-19). Design Living review network meta-analysis (NMA). Data sources WHO covid-19 database, comprehensive multilingual source global literature to 4 March 2022. Study selection Randomised trials in which people at risk were allocated or no (standard care placebo). Pairs reviewers independently screened potentially eligible articles. Methods After duplicate abstraction, we conducted random-effects bayesian meta-analysis. We assessed bias included studies using modification Cochrane 2.0 tool certainty evidence grading recommendations assessment, development evaluation (GRADE) approach. Results The iteration NMA includes 32 randomised enrolled 25 147 participants addressed 21 different prophylactic drugs; (66%), 18 162 (75%) 16 (76%) drugs. Of drugs analysed, none provided convincing reduction laboratory confirmed SARS-CoV-2 infection. For admission hospital mortality outcomes, proved than standard placebo. Hydroxychloroquine vitamin C combined with zinc probably increase adverse leading discontinuation—risk difference hydroxychloroquine (RD) 6 more per 1000 (95% credible interval (CrI) 10 more); zinc, RD 69 (47 90 more), moderate evidence. Conclusion Much remains very low therefore anticipate future evaluating may change results infection, outcomes. Both effects. Systematic registration was not registered. protocol established priori supplement. Funding study supported by Canadian Institutes Health Research (grant CIHR-IRSC:0579001321).

Language: Английский

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Self-medication practices to prevent or manage COVID-19: A systematic review

PLoS ONE, Journal Year: 2021, Volume and Issue: 16(11), P. e0259317 - e0259317

Published: Nov. 2, 2021

Background Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. Objective We conducted a to assess prevent or manage Methods used different keywords searched published PubMed, Scopus, Web Science, Embase, two preprint repositories, Google, Google Scholar. included that reported original data The risk bias was using Newcastle–Ottawa Scale (NOS) modified for cross-sectional studies. Results identified eight studies, all were cross-sectional, only one detailed question self-medication. recall period heterogeneous across Of seven without focusing on specific symptom: four performed general population (self-medication ranged between <4% 88.3%) three populations (range: 33.9% 51.3%). In these most medications varied widely, including antibiotics, chloroquine hydroxychloroquine, acetaminophen, vitamins supplements, ivermectin, ibuprofen. last study fever due Most had “representativeness sample” “assessment outcome” items NOS. Conclusions Studies COVID-19 found results regarding used. More well-designed adequately are warranted this topic.

Language: Английский

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Metabolic Implications of Oxidative Stress and Inflammatory Process in SARS-CoV-2 Pathogenesis: Therapeutic Potential of Natural Antioxidants

Frontiers in Cellular and Infection Microbiology, Journal Year: 2021, Volume and Issue: 11

Published: May 26, 2021

COVID-19 is a zoonotic disease with devastating economic and public health impacts globally. Being novel disease, current research focused on clearer understanding of the mechanisms involved in its pathogenesis viable therapeutic strategies. Oxidative stress inflammation are intertwined processes that play roles progression response to therapy via interference multiple signaling pathways. The redox status host cell an important factor viral entry due unique conditions required for conformational changes ensure binding virus into cell. Upon airways, replication occurs innate immune system responds by activating macrophage dendritic cells which contribute inflammation. This review examines available literature proposes oxidative could pathogenesis. Further, certain antioxidants currently undergoing some form trial patients corresponding gaps highlighted show how targeting ameliorate severity.

Language: Английский

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