| Outcome |
Relative effect
(95% CI) |
Absolute effect
(95% CI)1 |
Certainty of the Evidence
(GRADE) |
Clinical improvement
D28 |
RR: 2.50
(0.78 - 7.97) |
500 more per 1000
(from 73 fewer to 1000 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns in deviation from intended intervention, outcome measurement, and selection of reported result Inconsistency: Not serious Indirectness: Serious
Indirectness downgraded by 1 level: results are mainly from a single study from a single institution, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious
due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect and low number of participants
|
| 1 trials
Li T, 2020
18 participants
|
|
Bromhexine
833 per 1,000
(260 - 1000) |
Standard care
333
per 1,000 |
1 additional study was identified that assessed this outcome, but no results were reported. |
Clinical improvement
D60 |
Outcome not yet measured or reported
|
|
WHO progression score (level 7 or above)
D28 |
Outcome not yet measured or reported
|
1 study was identified that assessed this outcome, but no results were reported. |
WHO progression score (level 7 or above)
D60 |
Outcome not yet measured or reported
|
|
All-cause mortality
D28 |
RR: 0.37
(0.04 - 3.20) |
48 fewer per 1000
(from 74 fewer to 169 more)
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding sequence generation, deviation from intended intervention, missing data, and selection of reported results. Inconsistency: Not serious Indirectness: Serious
Indirectness downgraded by 1 level: studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious
Imprecision downgraded by 2 level: due to wide confidence interval consistent with the possibility for benefit and the possibility for harm and low number of participants
|
| 2 trials
Ansarin K, 2020; Tolouian R, 2021
189 participants
|
|
Bromhexine
28 per 1,000
(3 - 246) |
Standard care
77
per 1,000 |
1 additional study was identified that assessed this outcome, but no results were reported. |
All-cause mortality
D60 |
Outcome not yet measured or reported
|
|
Viral negative conversion
D7 |
RR: 0.61
(0.41 - 0.90) |
255 fewer per 1000
(from 386 fewer to 65 fewer)
|
Very low certainty
Reasons to downgrade
Risk of bias: Very serious
Risk of bias downgraded by 2 level: some concerns or high risk regarding randomization, deviation from intended interventions, missing data and selection of reported results. Inconsistency: Not serious Indirectness: Serious
Indirectness downgraded by 1 level: results are mainly from a single study from a single institution, therefore results in this population might not be generalizable to other settings. Imprecision: Serious
Imprecision downgraded by 1 level: due to low number of participants
|
| 1 trials
Tolouian R, 2021
100 participants
|
|
Bromhexine
399 per 1,000
(268 - 588) |
Standard care
654
per 1,000 |
|
Adverse events
|
RR: Not estimable |
Zero events in both groups
|
Very low certainty
Reasons to downgrade
Risk of bias: Serious
Risk of bias downgraded by 1 level: some concerns regarding randomization, deviation from intended intervention, and outcome measurement Inconsistency: Not serious Indirectness: Not serious
We presume that the adverse event rates, and the corresponding relative risks, is similar across diverse settings; therefore not downgraded for indirectness Imprecision: Very serious
no events in both groups and low number of participants Other considerations: none
|
| 1 trials
Ansarin K, 2020
78 participants
|
|
Bromhexine
0 per 1,000
( - ) |
Standard care
0
per 1,000 |
|
Serious adverse events
|
RR: Not estimable |
Zero events in both groups
|
Very low certainty
Reasons to downgrade
Risk of bias: Very serious
Risk of bias downgraded by 2 level: some concerns or high risk regarding randomization, deviation from intended interventions, missing data, outcome measurement and selection of reported results Inconsistency: Not serious Indirectness: Not serious
We presume that the adverse event rates, and the corresponding relative risks, is similar across diverse settings; therefore not downgraded for indirectness Imprecision: Very serious
no events in both groups and low number of participants
|
| 2 trials
Li T, 2020; Tolouian R, 2021
129 participants
|
|
Bromhexine
0 per 1,000
( - ) |
Standard care
0
per 1,000 |
|
1The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
