Catalina Verdejo1, Laura Vergara-Merino2, Nicolás Meza3, Javier Pérez-Bracchiglione4, Natalia Carvajal-Juliá5, Eva Madrid6, Gabriel Rada7, María Ximena Rojas Reyes8. 1. School of Medicine, Cochrane Chile Associated Centre, Universidad de Valparaíso, Chile. ORCID: 0000-0002-5293-5698. 2. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Cochrane Chile Associated Centre, Valparaíso, Chile. ORCID: 0000-0002-0004-3604. 3. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Cochrane Chile Associated Centre, Valparaíso, Chile. ORCID: 0000-0001-9505-0358. 4. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Cochrane Chile Associated Centre, Viña del Mar, Chile. ORCID: 0000-0001-8738-2184. 5. School of Medicine, Cochrane Chile Associated Centre, Universidad de Valparaíso, Chile. ORCID: 0000-0001-8020-3366. 6. Interdisciplinary Centre for Health Studies (CIESAL). Universidad de Valparaíso, Cochrane Chile Associated Centre, Valparaíso, Chile. ORCID: 0000-0002-8095-5549. 7. Fundación Epistemonikos, Santiago, Chile. ORCID: 0000-0003-2435-0710. 8. Department of Research, Fundación Cardioinfantil, Cochrane Colombia Affiliate Centre, Bogotá, Colombia. Adress: Calle 163A # 13B-60, Bogotá D.C., Colombia. Email: mxrojas@cardioinfantil.org. ORCID: 0000-0001-5752-7653.
Abstract
OBJECTIVE: This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: A living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases. METHODS: We included randomized trials evaluating the effect of macrolides as monotherapy or in combination with other drugs versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number: CRD42020181032 Protocol preprint DOI: 10.31219/osf.io/rvp59.
OBJECTIVE: This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: A living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases. METHODS: We included randomized trials evaluating the effect of macrolides as monotherapy or in combination with other drugs versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number: CRD42020181032 Protocol preprint DOI: 10.31219/osf.io/rvp59.
Authors: Larisa Pinte; Alexandr Ceasovschih; Cristian-Mihail Niculae; Laura Elena Stoichitoiu; Razvan Adrian Ionescu; Marius Ioan Balea; Roxana Carmen Cernat; Nicoleta Vlad; Vlad Padureanu; Adrian Purcarea; Camelia Badea; Adriana Hristea; Laurenţiu Sorodoc; Cristian Baicus Journal: J Pers Med Date: 2022-05-26
Authors: Luis Fernando Valladales-Restrepo; Camilo Alexander Constain-Mosquera; María Alejandra Hoyos-Guapacha; Karol Liceth Hoyos-Guapacha; Andrés Gaviria-Mendoza; Manuel Enrique Machado-Duque; Jorge Enrique Machado-Alba Journal: Biomedica Date: 2022-06-01 Impact factor: 1.173