Table 1 Baseline characteristics of the included studies
Author | Year | Design | Agent | Population | Intervention | Control | Age (years) | Male (%) | Main findings |
|---|---|---|---|---|---|---|---|---|---|
Bikdeli et al. [21] | 2022 | 2*2 factorial RCT | Statin | COVID-19 cases admitted to ICU (n = 587) | Atorvastatin 20 mg orally once daily (n = 290) | Placebo (n = 297) | 56.4 ± 16.7 | 56.4 | No significant difference in the occurrence of the primary outcome (arterial thrombosis, venous thrombosis, ECMO, or 30-day mortality) between the atorvastatin group (95 patients; 33%) and the placebo (108 patients; 36%) with an OR of 0.84 [95% CI 0.58–1.21] |
Davoodi et al. [14] | 2021 | Double-blind RCT | Statin | Hospitalized COVID-19 cases (n = 40) | Atorvastatin 40 mg orally once + lopinavir/ritonavir (n = 20) | Lopinavir/ritonavir (n = 20) | 46.0 ± 6.9 | 52.5 | The hospital stay duration was significantly reduced in the lopinavir/ritonavir + atorvastatin group in comparison with the control group (P = 0.012). However, no significant difference was observed between the need for mechanical ventilation and the need for immunoglobulin and interferon |
Ghafoori et al. [22] | 2022 | Open-label RCT | Statin | Hospitalized COVID-19 cases (n = 154) | Atorvastatin 20 mg orally once daily + lopinavir/ritonavir (n = 76) | Lopinavir/ritonavir (n = 78) | 50.6 ± 21.1 | 50.6 | A total of seven patients died, including two patients (2.6%) from controls and five (6.6%) in the atorvastatin group. The mean hospitalization duration days (p = 0.001) and the frequency of hospitalization in the ICU ward (18.4% vs. 1.3%) were longer in the intervention group. Moreover, the pulse rate (p = 0.004) was reported to be higher in the intervention group |
Ghati et al. [23] | 2022 | Open-label RCT | Statin | Hospitalized COVID-19 cases (n = 440) | Atorvastatin 40 mg orally once daily (n = 221) | Control (n = 219) | 52.2 ± 10.4 | 73.7 | There was no statistical difference between the atorvastatin and the control groups in terms of mortality, mechanical ventilation, clinical deterioration, and hospital stay length |
Hejazi et al. [24] | 2022 | Triple-blind RCT | Statin | Hospitalized COVID-19 cases (n = 40) | Atorvastatin 20 mg orally once daily (n = 20) | Placebo (n = 20) | 54.6 ± 14.7 | 70.0 | Atorvastatin had a significant impact on the reduction of oxygen need, serum hs-CRP levels, and hospitalization duration in hospitalized COVID-19 patients with mild-to-moderate disease |
Doaei et al. [13] | 2021 | Double-blind RCT | Omega-3 | Critically ill COVID-19 patients (n = 101) | Omega-3 1000 mg daily (n = 28) | Nutritional support (n = 73) | 64.5 ± 14.3 | 59.4 | The one-month survival rate was significantly higher in the intervention group. Also, higher levels of arterial pH, HCO3, and Be and lower levels of BUN, Cr, and K were found in the intervention group compared with the control group (all p < 0.05) |
Pawelzik et al. [26] | 2023 | Open-label RCT | Omega-3 | Hospitalized COVID-19 cases (n = 20) | n-3 PUFA emulsion containing 0.1 g/mL of fish oil (n = 10) | Placebo (n = 10) | 80.7 ± 6.2 | 45 | IV n-3 PUFA changed eicosanoid metabolites and decreased inflammatory and thrombosis mediators’ levels. Moreover, 15-F2t-isoprostane, as an oxidative stress marker was reduced in the intervention arm who had lower erythrocyte oxidative stress as well |
Chirinos et al. [16] | 2022 | Double-blind RCT | Fenofibrate | COVID-19 cases (outpatient and inpatient) (n = 701) | Fenofibrate (n = 351) | Placebo (n = 350) | 49 ± 16 | 52.9 | There was no statistical difference in all-cause mortality between the arms. There were 61 (17%) adverse events reported in the placebo arm in comparison to 46 (13%) in the fenofibrate group. Additionally, the incidence of gastrointestinal side effects was slightly higher in patients receiving fenofibrate |
Hu et al. [15] | 2022 | Open-label RCT | Nicotinamide | Hospitalized COVID-19 cases (mild/moderate) (n = 24) | Nicotinamide (n = 12) | Routine treatments (n = 12) | 69.5 ± 12 | 45.8 | In COVID-19 patients, the whole blood counts and absolute lymphocyte counts did not change significantly in any of the groups (intervention and control) (p > 0.05) |
Navarese et al. [25] | 2023 | Double-blind RCT | PSCK9 inhibitor | Severe hospitalized COVID-19 patients (n = 60) | Evolocumab (n = 30) | Placebo (n = 30) | 66.1 ± 12 | 61.7 | Patients receiving PCSK9 inhibitor exhibited a lower rate of the primary endpoint (30-day mortality or need for intubation) (23.3% vs. 53.3%). Also, the intervention group had significantly lower oxygen therapy duration and length of hospital stay, compared to the placebo group |