Efficacy and Safety of First-Line Therapeutic Drugs with Potential for the Treatment of Novel Coronavirus Pneumonia: A Meta-Analysis

Abstract

Background: Novel coronavirus pneumonia is spreading all over the world. While countries are actively dealing with the epidemic situation, the lack of specific drugs also indirectly makes the situation hard to control. At present, the internationally controversial first-line treatment drugs cover Hydroxychloroquine, Favipiravir, Remdesivir and so on. Methods: To evaluate the efficacy and safety of first-line treatment drugs for novel coronavirus pneumonia, this study investigated the turning-negative rate in the viral nucleic acid, survival rate and adverse reactions rate of novel coronavirus pneumonia patients under treated with Hydroxychloroquine, Azithromycin, Favipiravir and Remdesivir by performing meta-analysis. Findings: The result showed that hydroxychloroquine could not improve the turning-negative rate in the viral nucleic acid detection of novel coronavirus pneumonia patients compared with conventional therapy (RR=0·925, 95% CI (0·685, 1·250), P=0·61), and at the same time, it also associated with high adverse reactions rate up to 21·6%. Hydroxychloroquine combined with azithromycin can significantly increase the turning-negative rate to almost 62%, but patients’ survival rate is reduced for serious adverse reaction. The efficacy of favipiravir is stable (RR=2·70, 95% CI (1·25, 5·85), P=0·012) and its adverse reaction is under control (ES=6·10%, 95% CI (0·000, 0·121)). Remdesivir shows its therapeutic potential, but the high rate of adverse reactions (ES=58·20%, 95% CI (0·316, 0·848)) is also worthy of attention. More high-quality clinical trial data is required to investigate the efficacy and safety of first-line treatment drugs in further research. Interpretation: In summary, this article found that the clinical medication regimen for patients with mild and common COVID-19 is hydroxychloroquine 400mg/day or favipiravir 1200mg/day, and could be appropriately combined with conventional treatment, such as oxygen theraphy and carrimyclin, abidol, etc. For patients with severe COVID-19, daily use of remdesivir 100~200mg has the best effect, the treatment of hydroxychloroquine combined with azithromycin is regarded as the a last resort because of its severe adverse reaction and it can be combined with oxygen therapy together with other antibacterial drugs. And we suggest FDA to approve the favipiravir to use for patients and decrease the use of hydroxychloroquine combined with azithromycin. Funding Statement: This research work was supported by the National Natural Science Foundation of China (Grant No. 81973180 and No. 81673298), the Natural Science Foundation of the Jiangsu Higher Education Institutions of China for Excellent Young Talents (Grant No. BK20180077) and the Drug Innovation Major Project (2019ZX09301-142.) Declaration of Interests: The authors declare no competing interests.