Drug treatments for COVID-19
EVIDENCE AT A GLANCE
As of December 3, 2020, we analysed
43 trials
41 669 patients
339 drug comparisons
11 outcomes
We identified an additional 45 trials, that will be included in the next update.
See summary of estimates of effect for each treatment and outcome.
See data and risk of bias assessments for each study.
Read publications related to our drug treatment LNMA.
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DETAILED NARRATIVE SUMMARIES
Efficacy & safety of all drugs
Mortality | Mechanical ventilation | Time to symptom resolution
Adverse events leading to discontinuation
Safety of remdesivir, hydroxychloroquine and lopinavir-ritonavir
Mortality
Last updated: December 14, 2020
74 trials randomising 51, 038 patients
Corticosteroids likely reduce mortality. Recombinant Human Granulocyte Colony-Stimulating Factor and ivermectin may reduce mortality. There is no convincing evidence yet that any of the other treatments have a mortality benefit when compared with standard care or each other.
What to GRADE certainty ratings mean?
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Very low: true effect is probably markedly different from the estimated effect.
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Low: true effect might be markedly different from the estimated effect.
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Moderate: we believe true effect is probably close to the estimated effect.
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High: we have a lot of confidence that the true effect is similar to the estimated effect.
130 deaths per 1,000
in standard care group
Drugs that are among the most effective and have high or moderate certainty evidence probably reduce mortality.
Drugs that are among the most effective and have low or very low certainty evidence might reduce mortality.
Drugs that are not different than standard care and have high or moderate certainty evidence probably do not reduce on mortality.
Drugs that are not different than standard care and have low or very low certainty evidence may not reduce mortality.
Mechanical ventilation
Last updated: October 21, 2020
40 trials randomising 33, 727 patients
Corticosteroids likely reduce the need for mechanical ventilation. Recombinant Human Granulocyte Colony-Stimulating Factor may reduce the need for mechanical ventilation.
Time to symptom resolution
Last updated: October 21, 2020
32 trials randomising 4, 424
Remdesivir probably does not reduce the time to symptoms resolution. There is no convincing evidence that any of the other treatments reduce time to symptom resolution when compared with standard of care or each other.
Adverse events leading to discontinuation
Last updated: October 21, 2020
32 trials randomising 4, 698 patients
Remdesivir probably does not importantly increase the risk of adverse events compared with standard care. Hydroxychloroquine and tocilizumab may not importantly increase the risk of adverse events leading to discontinuation.
Remdesivir
Last updated: October 27, 2020
2 trials randomising 1, 281 patients:
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2 trials (1, 281 patients) reporting on acute kidney injury
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1 trial (1, 048) reporting on cognitive dysfunction
Remdesivir may have little or no effect on acute kidney injury or cognitive dysfunction/delirium when compared to placebo.
Hydroxychoroquine
Last updated: October 27, 2020
10 trials randomising 3, 663 patients:
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7 trials (3, 287 patients) reporting on cardiac toxicity
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6 trials (979 patients) reporting on diarrhoea
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7 trials (1, 429 patients) reporting on nausea and/or vomiting
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1 trial (234 patients) reporting on cognitive function/delirium
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2 trials (180 patients) reporting on fatigue
Hydroxychloroquine may increase the risk of cardiac toxicity and cognitive dysfunction/delirium when compared to standard care or placebo. Hydroxychloroquine probably increases the risk of diarrhoea, and nausea and/or vomiting when compared to standard care or placebo. The effect of hydroxychloroquine on fatigue is uncertain when compared to standard care or placebo.
Hydroxychoroquine with azithromycin
Last updated: October 27, 2020
1 trial randomising 667 patients
The effect of hydroxychloroquine with azithromycin on cardiac toxicity and nausea and/or vomiting is uncertain when compared to standard care or placebo.
Lopinavir/ritonavir
Last updated: October 27, 2020
4 trials randomising 370 patients:
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4 trials (370 patients) reporting on diarrhoea
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4 trials (370 patients) reporting on nausea and/or vomiting
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2 trials (259) patients reporting on acute kidney injury
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2 trials (254 patients) reporting on fatigue
Lopinavir/ritonavir may increase the risk of diarrhoea and nausea and/or vomiting when compared to standard care or
placebo. The effect of lopinavir/ritonavir on acute kidney injury and fatigue is uncertain when compared to standard
care or placebo.