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

被引：78

作者：

Bartoszko, Jessica J. ^{[1
]}

Siemieniuk, Reed A. C.

Kum, Elena ^{[1
]}

Qasim, Anila ^{[1
]}

Zeraatkar, Dena ^{[1
]}

Ge, Long ^{[2
]}

Han, Mi Ah ^{[3
]}

Sadeghirad, Behnam ^{[1
,4
]}

Agarwal, Arnav ^{[1
,5
]}

Agoritsas, Thomas ^{[1
,6
,7
]}

Chu, Derek K. ^{[1
,8
]}

Couban, Rachel ^{[4
]}

Darzi, Andrea J. ^{[1
]}

Devji, Tahira ^{[1
]}

Ghadimi, Maryam ^{[1
]}

Honarmand, Kimia ^{[9
]}

Izcovich, Ariel ^{[10
]}

Khamis, Assem ^{[11
]}

Lamontagne, Francois ^{[12
,13
]}

Loeb, Mark ^{[1
,8
]}

Marcucci, Maura ^{[1
,8
]}

McLeod, Shelley L. ^{[14
,15
]}

Motaghi, Sharhzad ^{[1
]}

Murthy, Srinivas ^{[16
]}

Mustafa, Reem A. ^{[17
]}

Neary, John D. ^{[8
]}

Pardo-Hernandez, Hector ^{[18
,19
]}

Rada, Gabriel ^{[20
,21
]}

Rochwerg, Bram ^{[1
]}

Switzer, Charlotte ^{[1
]}

Tendal, Britta ^{[22
]}

Thabane, Lehana ^{[1
]}

Vandvik, Per O. ^{[23
]}

Vernooij, Robin W. M. ^{[24
,25
]}

Viteri-Garcia, Andres ^{[20
,26
]}

Wang, Ying ^{[1
]}

Yao, Liang ^{[1
]}

Ye, Zhikang ^{[1
]}

Guyatt, Gordon H. ^{[1
,8
]}

Brignardello-Petersen, Romina ^{[1
]}

机构：

[1] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[2] Lanzhou Univ, Sch Publ Hlth, Evidence Based Social Sci Res Ctr, Lanzhou, Gansu, Peoples R China

[3] Chosun Univ, Dept Prevent Med, Coll Med, Gwangju, South Korea

[4] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada

[5] Univ Toronto, Dept Med, Toronto, ON, Canada

[6] Univ Hosp Geneva, Div Gen Internal Med, Geneva, Switzerland

[7] Univ Hosp Geneva, Div Clin Epidemiol, Geneva, Switzerland

[8] McMaster Univ, Dept Med, Hamilton, ON, Canada

[9] Western Univ, Dept Med, London, ON, Canada

[10] Hosp Aleman, Serv Clin Med, Buenos Aires, DF, Argentina

[11] Hull York Med Sch, Wolfson Palliat Care Res Ctr, York, N Yorkshire, England

[12] CHU Sherbrooke, Dept Med, Sherbrooke, PQ, Canada

[13] CHU Sherbrooke, Ctr Rech, Sherbrooke, PQ, Canada

[14] Sinai Hlth, Schwartz Reisman Emergency Med Inst, Toronto, ON, Canada

[15] Univ Toronto, Dept Family & Community Med, Toronto, ON, Canada

[16] Univ British Columbia, Dept Pediat, Fac Med, Vancouver, BC, Canada

[17] Univ Kansas, Med Ctr, Dept Med, Kansas City, MO USA

[18] St Pau Biomed Res Inst IIB St Pau, Iberoamer Cochrane Ctr, Barcelona, Spain

[19] CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain

[20] Epistemonikos Fdn, Santiago, Chile

[21] Pontificia Univ Catolica Chile, Cochrane Chile Associated Ctr, C Evidence Ctr, Santiago, Chile

[22] Monash Univ, Sch Publ Hlth & Preventat Med, Melbourne, Vic, Australia

[23] Univ Oslo, Inst Hlth & Soc, Oslo, Norway

[24] Univ Med Ctr Utrecht, Dept Nephrol & Hypertens, Utrecht, Netherlands

[25] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[26] Univ UTE, Fac Ciencias Salud Eugenio Espejo, Ctr Invest Salud Publ & Epidemiol Clin CISPEC, Quito, Ecuador

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2021年 / 373卷

基金：

加拿大健康研究院;

关键词：

IVERMECTIN;

D O I：

10.1136/bmj.n949

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE To determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19. DESIGN Living systematic review and network meta-analysis. DATA SOURCES World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 25 March 2021, and six additional Chinese databases to 20 February 2021. STUDY SELECTION Randomised trials of people at risk of covid-19 who were assigned to receive prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles. METHODS Random effects bayesian network meta-analysis was performed after duplicate data abstraction. Included studies were assessed for risk of bias using a modification of the Cochrane risk of bias 2.0 tool, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. RESULTS The first iteration of this living network meta-analysis includes nine randomised trials-six of hydroxychloroquine (n=6059 participants), one of ivermectin combined with iota-carrageenan (n=234), and two of ivermectin alone (n=540), all compared with standard care or placebo. Two trials (one of ramipril and one of bromhexine hydrochloride) did not meet the sample size requirements for network meta-analysis. Hydroxychloroquine has trivial to no effect on admission to hospital (risk difference 1 fewer per 1000 participants, 95% credible interval 3 fewer to 4 more; high certainty evidence) or mortality (1 fewer per 1000, 2 fewer to 3 more; high certainty). Hydroxychloroquine probably does not reduce the risk of laboratory confirmed SARS-CoV-2 infection (2 more per 1000, 18 fewer to 28 more; moderate certainty), probably increases adverse effects leading to drug discontinuation (19 more per 1000, 1 fewer to 70 more; moderate certainty), and may have trivial to no effect on suspected, probable, or laboratory confirmed SARS-CoV-2 infection (15 fewer per 1000, 64 fewer to 41 more; low certainty). Owing to serious risk of bias and very serious imprecision, and thus very low certainty of evidence, the effects of ivermectin combined with iota-carrageenan on laboratory confirmed covid-19 (52 fewer per 1000, 58 fewer to 37 fewer), ivermectin alone on laboratory confirmed infection (50 fewer per 1000, 59 fewer to 16 fewer) and suspected, probable, or laboratory confirmed infection (159 fewer per 1000, 165 fewer to 144 fewer) remain very uncertain. CONCLUSIONS Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection. Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection.

引用

页数：12

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