Background: Limited data on the efficacy and safety of currently applied
COVID-19 therapeutics and their impact on
COVID-19 outcomes have raised additional concern. Objective and Methods: To estimate the efficacy and safety of
COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of
COVID-19 published from January 21 to September 6, 2020. Results: We included 136 studies that involved 102,345
COVID-19 patients. The most prevalent treatments were
antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and
antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of
lopinavir/
ritonavir and
Arbidol was the most effective in treating
COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of
corticosteroids was associated with a small clinical improvement (SMD = -0.40, 95% CI: [-0.85, -0.23]), but with a higher risk of
disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of
hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of
lopinavir/
ritonavir,
ribavirin, and
interferon-β (RR = 0.34, 95% CI: [0.22, 0.54]);
hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and
lopinavir/
ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length.
Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and
remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events.
Dexamethasone was not significant in reducing
disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of
corticosteroids with
antivirals was associated with a better clinical improvement than
antivirals alone (SMD = -1.09, 95% CI: [-1.64, -0.53]). Conclusion:
Antivirals are safe and effective in
COVID-19 treatment.
Remdesivir cannot significantly reduce
COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events.
Corticosteroids could increase
COVID-19 severity, but it could be beneficial when combined with
antivirals. Our data are potentially valuable for the clinical treatment and management of
COVID-19 patients.