Pharmacologic treatments for covid-19 patients

We are searching the literature every day and collecting data for each RCT of COVID-19 treatment identified.

Below you can access all the treatment comparisons where data are available as well as a table with the general characteristics of each trial. For each treatment comparison, you can access the forest plots for all the outcomes of interest available as well as the Summary of Findings (SoF) table.

We are updating the evidence synthesis every Friday: this was last updated on July 17, 2020.

This week, we updated the data of the below stated studies following supplementary information received by authors, preprint update, or quality control. Wang Y, Lancet, 2020; Zheng F, medRxiv, 2020; Tang W, Bmj, 2020; Chen J, Journal of Zhejiang University , 2020; Gharbharan A, medRxiv, 2020; Cao Y, J Allergy Clin Immunol, 2020; Horby P, medRxiv, 2020 (RECOVERY Trial); Chen J, Open Forum Infect Dis, 2020; Horby P, medRxiv, 2020; Mitja O, Clin Infect Dis, 2020; Skipper CP, Ann Intern Med, 2020; Cao B, N Engl J Med, 2020; Hung IF-N, Lancet, 2020.

Treatment comparisons

We report below the forest plots for the main treatment comparisons.

Please choose a Treatment Comparison:

  • Remdesivir vs Placebo
  • Dexamethasone vs Standard Care
  • Lopinavir + Ritonavir vs Standard care
  • Hydroxychloroquine + Azithromycin vs Standard Care
  • Lopinavir + Ritonavir + Ribavirin + Interferon-b-1b vs Lopinavir + Ritonavir
  • Hydroxychloroquine + Azithromycin vs Hydroxychloroquine
  • Umifenovir vs Standard care
  • Hydroxychloroquine vs Standard care/Placebo
  • Chloroquine vs Standard Care
  • Umifenovir vs Lopinavir + Ritonavir
  • Favipiravir vs Umifenovir
  • a-Lipoic acid vs Placebo
  • Novaferon + Lopinavir + Ritonavir vs Lopinavir + Ritonavir
  • Novaferon + Lopinavir + Ritonavir vs Novaferon
  • Novaferon vs Lopinavir + Ritonavir
  • Baloxavir marboxil vs Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a
  • Favipiravir vs Baloxavir marboxil
  • Favipiravir vs Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a
  • Colchicine vs Standard Care
  • Intravenous Immunoglobulin vs Standard Care
  • Convalescent plasma vs Standard care
  • Hydroxychloroquine vs Chloroquine
  • Darunavir/cobicistat vs Standard Care
  • Ruxolitinib vs Placebo
  • Interferon β-1a vs Standard care

Reboot the table and see all comparisons

Network diagrams

Networks

The nodes represent the interventions being compared in the available RCTs. Two interventions are connected with a line whenever there is at least one RCT comparing them directly. The size of the nodes is proportional to the total number of participants randomised in each intervention and the thickness of the line is proportional to the precision (i.e. the inverse of the variance) of the relative effect for the respective direct comparison. The color of the lines represents the overall risk of bias of the direct comparisons for the outcome that corresponds to each network diagram. When two or more RCTs compare the same pair of interventions, then the risk of bias of that comparison is calculated as the inverse variance weighted average of the study-specific overall risk of bias judgements.

Description of primary studies

In this table, we report the main characteristics of the RCTs identified.

The link in the column Overall risk of bias will give you access to a complete description of the assessment of each risk of bias domain with supports for judgement. The overall risk of bias reported in the table corresponds to the highest risk of bias for the outcomes assessed for the systematic review. The link in the column Full description will give you access to the general characteristics of the study.

The components included in the standard of care vary among the included studies. For example, the standard of care may include antiviral treatments in some studies, but not in others. We are in the process of contacting the study authors to obtain more information.

We acknowledge that we may have been unable to extract some information from pre-prints, as they represent preliminary forms of scientific communication. We perform daily database searches to identify if an included pre-print has been published in a scientific journal, and we will use the published paper to update our extraction.

This week, we updated the data of the below stated studies following supplementary information received by authors, preprint update, or quality control. Wang Y, Lancet, 2020; Zheng F, medRxiv, 2020; Tang W, Bmj, 2020; Chen J, Journal of Zhejiang University , 2020; Gharbharan A, medRxiv, 2020; Cao Y, J Allergy Clin Immunol, 2020; Horby P, medRxiv, 2020 (RECOVERY Trial); Chen J, Open Forum Infect Dis, 2020; Horby P, medRxiv, 2020; Mitja O, Clin Infect Dis, 2020; Skipper CP, Ann Intern Med, 2020; Cao B, N Engl J Med, 2020; Hung IF-N, Lancet, 2020.

Trial Funding Comparisons Design Participants Sample size Overall risk
of bias
Full description
Treatment 1 Treatment 2
NCT04381936
Horby P, medRxiv, 2020 (RECOVERY Trial)
Full text
Commentary
Public Dexamethasone Standard care RCT Patients with confirmed and unconfirmed COVID-19 (moderate to critical) admitted to 176 hospitals in the United Kingdom N=6425
Some concerns
Details

Full description

Forest plot
(sub group)
NCT04252274
Chen J, Open Forum Infect Dis, 2020
Full text
Commentary
Public/non profit Darunavir/cobicistat Standard care RCT Patients with COVID-19 (moderate) admitted to a single center in China N=30
High
Details

Full description

NCT04381936
Horby P, medRxiv, 2020
Full text
Commentary
Mixed Hydroxychloroquine Standard care RCT Patients with COVID-19 (mild-critical) admitted to 176 centers in the UK N=4716
Some concerns
Details

Full description

NCT04308668
Skipper CP, Ann Intern Med, 2020
Full text
Commentary
Private Hydroxychloroquine Placebo RCT Symptomatic, non-hospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 with high-risk exposure within 4 days of symptom onset. N=491
Some concerns
Details

Full description

NCT04411667
Sakoulas G, medRxiv, 2020
Full text
Commentary
Private Intravenous Immunoglobulin Standard care RCT Patients with confirmed COVID-19 (moderate-severe) admitted to 2 centers in USA. N=34
Some concerns
Details

Full description

new
RPCEC00000307
Esquivel-Moynelo I, medRxiv, 2020
Full text
Commentary
Public/non profit IFN alpha2b+IFN gamma Interferon alpha2b RCT Patients with confirmed COVID-19 (ambulatory, mild) admitted to a single center in Cuba N=79
Some concerns
Details

Full description

NCT04257656
Wang Y, Lancet, 2020
Full text
Commentary
Mixed Remdesivir Placebo RCT Patients with confirmed COVID-19 (severe) admitted to ten centers in China. N=237
Some concerns
Details

Full description

NCT04280705
Beigel JH, N Engl J Med, 2020
Full text
Commentary
Public/non profit Remdesivir Placebo RCT Patients with confirmed COVID-19 (moderate to critical) admitted to 60 sites in 10 countries. N=1063
Some concerns
Details

Full description

NCT04292899
Goldman JD, N Engl J Med, 2020
Full text
Commentary
and Commentary
Private Remdesivir 5 Days Remdesivir 10 Days RCT Patients with confirmed COVID-19 (moderate to critical) admitted to 55 centers across 5 countries. N=402
Some concerns
Details

Full description

Forest plots
ChiCTR2000029308
Cao B, N Engl J Med, 2020
Full text
Commentary
and Commentary
Mixed Lopinavir + Ritonavir Standard care RCT Patients with confirmed COVID-19 (severe) admitted to a single center in China. N=199
Some concerns
Details

Full description

NCT04252885
Yueping L, CellPress, 2020
Full text
Commentary
Public/non profit Lopinavir + Ritonavir Standard care RCT Patients with confirmed COVID-19 (mild-moderate) admitted to a single center in China. N=86
Some concerns
Details

Full description

Umifenovir Lopinavir + Ritonavir
Umifenovir Standard care
NCT04276688
Hung IF-N, Lancet, 2020
Full text
Commentary
and Commentary
Not reported/unclear Lopinavir + Ritonavir + Ribavirin + Interferon-b-1b Lopinavir + Ritonavir RCT Patients with confirmed COVID-19 (unclear severity) admitted to six centers in Hong-Kong. N=127
Some concerns
Details

Full description

ChiCTR2000030254
Chen C, medRxiv, 2020
Full text
Commentary
Public/non profit Favipiravir Umifenovir RCT Patients with confirmed COVID-19 (moderate and severe) admitted to 3 centers in China. N=240
High
Details

Full description

ChiCTR2000029868
Tang W, BMJ, 2020
Full text
Commentary
and Commentary
Mixed Hydroxychloroquine Standard care RCT Patients with COVID-19 (mild, moderate and severe) admitted to 16 centers in China N=150
Some concerns
Details

Full description

NCT04261517
Chen J, J Zhejiang Univ, 2020
Full text
Public/non profit Hydroxychloroquine Standard care RCT Treatment-naive patients with confirmed COVID-19 (moderate) admitted to a single center in China. N=30
High
Details

Full description

ChiCTR2000029559
Chen Z, medRxiv, 2020
Full text
Commentary
and Commentary
Public/non profit Hydroxychloroquine Standard care RCT Patients with confirmed COVID-19 (moderate) admitted to a single center in China. N=62
High
Details

Full description

NCT04323527
Borba MGS, Jama Netw Open, 2020
Full text
Commentary
Public/non profit Chloroquine - 600mg Chloroquine - 450mg RCT Patients with severe and critical respiratory syndrome secondary to SARS-CoV-2 infection treated in a single center in Brazil. N=81
Some concerns
Details

Full description

Forest plots
ChiCTR2000029851
Zhong M, medRxiv, 2020
Full text
Commentary
Private a-Lipoic acid Placebo RCT Patients with confirmed COVID-19 (severe-critical) admitted to 1 center in China. N=17
Some concerns
Details

Full description

ChiCTR2000029496
Zheng F, medRxiv, 2020
Full text
Commentary
Public/non profit Novaferon Lopinavir + Ritonavir RCT Patients with confirmed COVID-19 (moderate-severe) admitted to a single center in China. N=89
Some concerns
Details

Full description

Novaferon + Lopinavir + Ritonavir Lopinavir + Ritonavir
Novaferon + Lopinavir + Ritonavir Novaferon
ChiCTR2000029544
Lou Y, medRxiv, 2020
Full text
Commentary
Public/non profit Favipiravir Baloxavir marboxil RCT Patients with confirmed COVID-19 (unclear severity) admitted to a single center in China. N=30
Some concerns
Details

Full description

Baloxavir marboxil Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a
Favipiravir Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a
ChiCTR-OPN-2000029580
Cao Y, J Allergy Clin Immunol, 2020
Full text
Commentary
Public/non profit Ruxolitinib Placebo RCT Patients with COVID-19 (severe) admitted to 3 centers in China. N=43
Some concerns
Details

Full description

IRCT20100228003449N28
Davoudi-Monfared E, medRxiv, 2020
Full text
Commentary
Private Interferon b-1a Standard care RCT Patients with COVID-19 (moderate to critical) admitted to 1 center in Iran. N=92
High
Details

Full description

ChiCTR2000029757
Li L, JAMA, 2020
Full text
Commentary
Commentary
Public/non profit Convalescent plasma Standard care RCT Patients with COVID-19 (severe to critical) admitted to 7 centers in China. N=103
High
Details

Full description

ChiCTR2000030054
Chen L, medRxiv, 2020
Full text
Commentary
Public Hydroxychloroquine Chloroquine RCT Patients with confirmed COVID-19 (mild, moderate) admitted to a single center in China N=67
High
Details

Full description

Chloroquine Standard care
Hydroxychloroquine Standard care
NCT04326790
Deftereos SG, JAMA, 2020
Full text
Commentary
Private Colchicine Standard care RCT Patients with COVID-19 (moderate-severe) admitted to 16 centers in Greece. N=110
Some concerns
Details

Full description

NCT04342182
Gharbharan A, medRxiv, 2020
Full text
Commentary
Mixed Convalescent plasma Standard care RCT Patients with COVID-19 (moderate-critical) admitted to 14 centers in the Netherlands N=86
High
Details

Full description

new
NCT04322123
Cavalcanti AB, N Engl J Med, 2020
Full text
Commentary
Mixed Hydroxychloroquine Standard care RCT Patients with suspected or confirmed COVID-19 (mild-moderate) admitted to 55 centers in Brazil N=667
High
Details

Full description

Hydroxychloroquine + Azithromycin Standard care
Hydroxychloroquine + Azithromycin Hydroxychloroquine