AIMS: To perform network meta‐analysis for a head‐to‐head comparison of various interventions used in coronavirus disease 2019 (COVID‐19) on mortality, clinical recovery, time to clinical improvement and the occurrence of serious adverse events. METHODS: Systematic search was performed using online databases with suitable MeSH terms including coronavirus, COVID‐19, randomized controlled trial, hydroxychloroquine, lopinavir/ritonavir, tocilizumab, remdesivir, favipiravir, dexamethasone and interferon‐β. Data were independently extracted by 2 study investigators and analysed. RESULTS: Out of 1225 studies screened, 23 were included for qualitative and quantitative analysis. Among the drugs studied, dexamethasone reduces mortality by 10%, with a relative risk of 0.90 (95% confidence interval [0.82–0.97]) and increases clinical recovery by 6% (relative risk 1.06, 95% confidence interval [1.02–1.10]) compared to standard of care. Similarly, remdesivir administered for 10 days increased clinical recovery by 10%, reduced time to clinical improvement by 4 days and lowered the occurrence of serious adverse events by 27% as compared to standard of care. CONCLUSION: In comparison to standard of care, dexamethasone was found to increase clinical recovery and lower mortality; remdesivir was significantly associated with a lower risk of mortality as compared to tocilizumab and higher clinical recovery and shorter time to clinical improvement as compared to hydroxychloroquine and tocilizumab; remdesivir followed by tocilizumab were found to have lesser occurrence of serious adverse events in patients with moderate to severe COVID‐19.
Efficacy of pharmacological interventions in COVID‐19: A network meta‐analysis