Rationale and prognosis of repurposed drugs with risk stratification of patients in oxygen support in COVID-19: A systematic review and meta-analysis

BackgroundThe rising number of trials on repurposed dugs in COVID-19 has led to duplication and a need for curation of available outcomes from treatments that have been followed across the world. We have conducted a systematic review and meta-analysis that focus on evaluating the clinical outcomes of repurposed interventions against COVID-19. MethodsRandom effects model was adopted to estimate overall treatment effect and heterogeneity. Meta- regression was performed to study the correlation between comorbid conditions and non- invasive or invasive ventilation requirement. ResultsTwenty-nine articles met our eligibility criteria. In subgroup analysis, Tocilizumab was highly significant with lower mortality rate (OR 27.50; 95%CI [5.39-140.24]) of severe COVID-19 patients. Hydroxychloroquine and Lopinavir-ritonavir was found to be inefficacious in severe patients (OR 0.64; 95%CI [0.47-0.86] and 1.40 [0.71-2.76]). Dexamethasone had marginal effect on overall mortality rate (OR 1.19; 95%CI [1.05-1.35]). The meta-regression shows a positive correlation between prevalence of patients on Tocilizumab in non invasive support and hypertension condition (P = 0.02), whereas a negative correlation was identified with patients having lung disease (P = 0.03). ConclusionOverall, our study confirmed that tocilizumab may probably reduce the mortality rate (<10%) of severe COVID-19 patients than other interventions. Further, reduce the risk of requiring non- invasive ventilator support in patients with comorbid condition of lung disease. Hydroxychloroquine and Lopinavir-ritonavir has no clinical benefits in severe COVID-19. A high quality evidence is required to evaluate the usage of Serpin + Favipiravir combination in severe or critical COVID-19.