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Cited by 11SARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research StudiesCOVID-19 epidemiological studies

Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis

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Zhou, Guiling, Verweij, Stefan, Bijlsma, Maarten J, de Vos, Stijn, Oude Rengerink, Katrien, Pasmooij, Anna Maria Gerdina, van Baarle, Debbie, Niesters, Hubert G M +3 more·2023·BMJ Open Respiratory Research
DOI 10.1136/bmjresp-2023-001674PMC PMC10462970
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Abstract

Objective: Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults. Design: Systematic review. Eligibility: Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease. Data source: PubMed and Embase (1 January 2020–28 September 2022). Risk of bias: Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies. Data analysis: Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available. Results: In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I 2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I 2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies. Conclusions: Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection. PROSPERO registration number: CRD42021292797.

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Authors
Zhou, G., Verweij, S., Bijlsma, M. J., de Vos, S., Oude Rengerink, K., Pasmooij, A. M. G., van Baarle, D., Niesters, H. G. M., Mol, P., Vonk, J. M., & Hak, E.
Affiliations
  • University of Groningen (NL)
  • Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
  • Dutch Medicines Evaluation Board, Utrecht, The Netherlands
  • Medicines Evaluation Board (NL)
  • Virology and Immunology Research Group, Department of Medical Microbiology and Infection Prevention, University Medical Centre, Groningen, The Netherlands
  • University Medical Center Groningen (NL)
Corresponding author
Zhou, Guiling
ORCID
Venue
BMJ Open Respiratory Research
Publisher
BMJ
Published
2023-08
Volume
10
Issue
1
Pages
e001674
ISSN
2052-4439 (ISSN-L)
DOI
10.1136/bmjresp-2023-001674
PMC
PMC10462970
OpenAlex
W4386226703
Cited by
11
References
4
Citations by year
2026: 4 · 2025: 4 · 2024: 2 · 2023: 1
FWCI
0.52
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Respiratory Research (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
Funders
China Scholarship Council (202107720033)
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
Keywords
SARS-CoV-2, COVID-19 pandemic, drug repurposing, prophylaxis, primary prevention, hydroxychloroquine, ivermectin, ACE inhibitors, angiotensin receptor blockers, statins, SARS-CoV-2 infection prevention, healthy adults, risk of bias
MeSH terms
COVID-19, SARS-CoV-2, Adult, Angiotensin-Converting Enzyme Inhibitors, Humans, Hydroxychloroquine, Ivermectin, Primary Prevention, Angiotensin Receptor Antagonists, Pandemics

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