Potentially Effective Drugs for the Treatment of COVID-19 in Children: A Systematic Review

Abstract

Background: The efficacy and safety of using potential drugs such as remdesivir, glucocorticoid, and intravenous immunoglobulin (IVIG) in treating children and adolescents with COVID-19 is unclear. Methods: We searched seven databases, three preprint platform, ClinicalTrials.gov, and Google from December 1, 2019, to March 2, 2021, to collect evidence of remdesivir, glucocorticoid, and IVIG which were used in children and adolescents with COVID-19. Findings: A total of six cohort studies and one case series study were included in this systematic review. In terms of remdesivir, the meta-analysis of single-arm cohort studies have shown that, after the treatment, 37·1% (95%CI, 0·0% to 74·5%) experienced adverse events, 5·9% (95%CI, 1·5% to 10·2%) died, 37.2% (95%CI, 0% to 76·0%) needed extracorporeal membrane oxygenation (ECMO) or invasive mechanical ventilation (IMV). As for glucocorticoids, the results of the meta-analysis showed that the fixed-effect summary odds ratio (OR) for the association with mortality was 2·79 (95%CI, 0·13 to 60·87), and the mechanical ventilation rate was 3·12 (95%CI, 0·80 to 12·08) for glucocorticoids compared with the control group. In terms of IVIG, the two included cohort studies showed that for MIS-C patients with more severe clinical symptoms, IVIG combined with methylprednisolone could achieve better clinical efficacy than IVIG alone. Interpretation: Overall, the current evidence in the included studies is insignificant and of low quality, which does not adequately demonstrate the effectiveness and safety of using remdesivir, glucocorticoids, and IVIG in treating children and adolescents with COVID-19 or MIS-C. Funding Information: This work was supported by grants from the National Clinical Research Center for Child Health and Disorders (Children’s Hospital of Chongqing Medical University, Chongqing, China) (grant number NCRCCHD-2020-EP-01); Special Fund for Key Research and Development Projects in Gansu Province in 2020; the Fourth Batch of “Special Project of Science and Technology for Emergency Response to COVID-19” of Chongqing Science and Technology Bureau; special funding for prevention and control of emergency of COVID-19 from Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province (grant number No. GSEBMKT-2020YJ01); The Fundamental Research Funds for the Central Universities (lzujbky-2020-sp14). Declaration of Interests: None.