Comparison of effectiveness of various treatment strategies in COVID-19 patients: A Systematic Review

  • Muhammad Shehryar Hussain Allama iqbal medical college Lahore
  • Ali Haider
  • Usama Ahmad Yousaf
  • Warisha Laraib
  • Fatima Dildar
  • Hafiz Amjad Hussain
Keywords: COVID-19 treatment, SARS-COV-2, convalescent plasma therapy, Lopinavir/ritonavir, Hydroxychloroquine and azithromycin, Remdesivir, COVID-19 serum therapy, coronavirus disease-19 drug treatment


Background: The purpose of this study is to systematically review the effectiveness of various drugs and therapies by assessing already conducted studies on COVID-19 patients.

Methods: The eligibility criterion for this systematic review was to include the observational and experimental studies including case reports; conducted on the possible treatments of COVID-19. Only those studies were included that were written in the English language either published or unpublished from December 2019 to April 10, 2020. Quality of articles was assessed and flawed studies were excluded based on incomplete outcome data. Treatment strategies experimented on animals or those assessed through artificial intelligence were also excluded. The databases searched were PubMed, Google Scholar, Cochrane Library, and bioRxiv. The last date to search the databases was April 10, 2020.

Results: We selected 25 articles which include 12 case studies, 10 retrospective studies, one randomized controlled trial, one non-randomized Controlled trial, and one prospective observational study. Hydroxychloroquine proved to be effective in all three studies under consideration especially when it was used in a combination with azithromycin. Antivirals showed significant results in eleven out of sixteen studies. The remaining five studies showed antiviral therapy to be ineffective. Lopinavir/ritonavir did not show satisfactory results in most of the COVID-19 patients. Both of the studies regarding convalescent plasma therapy showed significant improvement in patients undergoing treatment. Two studies regarding treatment with immunoglobulins also showed good results. A study on the use of Mesenchymal stem cell transplant for treatment of COVID-19 patients also proved to be effective. Likewise, a study on the use of Traditional Chinese Medicine along with Western Medicine also showed good results. In patients of organ transplant, withdrawal of immunosuppressive drugs, and the use of methylprednisolone along with antivirals had shown significantly good results. Among all these therapeutic approaches we found convalescent plasma therapy to be most effective.

Conclusion: So far, a small number of studies have been conducted on the treatment of COVID-19 patients and most of them were conducted on the Chinese population. More randomized controlled trials are needed to evaluate the effectiveness of different treatment strategies at a broader level.

Author Biographies

Ali Haider

4TH YEAR MBBS student Allama Iqbal Medical College,Lahore.

Usama Ahmad Yousaf

3RD YEAR MBBS student Allama Iqbal Medical College,Lahore.

Warisha Laraib

2ND YEAR MBBS student CMH Lahore Medical College

Fatima Dildar

4TH YEAR MBBS student Allama Iqbal Medical College,Lahore.

Hafiz Amjad Hussain

ASSISTANT PROFESSOR MEDICINE punjab medical college  Faisalabad medical university


1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 Mar 17;323(11):1061–9.
2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199–207.

3. Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents [Internet]. 2020 Mar [cited 2020 Apr 10];105949. Available from:
4. Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends. 2020 Mar 16;14(1):64–8.
5. Cheng C, Lee Y, Chen C, Lin Y, Liu C, Liao C, et al. Lopinavir/ritonavir did not shorten the duration of SARS CoV-2 shedding in patients with mild pneumonia in Taiwan. J Microbiol Immunol Infect [Internet]. 2020; Available from:
6. Mukherjee A, Ahmad M, Frenia D. A Coronavirus Disease 2019 ( COVID-19 ) Patient with Multifocal Pneumonia Treated with Hydroxychloroquine. 2020;2019(3).
7. Zheng C, Wang J, Guo H, Lu Z, Ma Y, Zhu Y, et al. Risk-adapted Treatment Strategy For COVID-19 Patients. Int J Infect Dis. 2020 Mar;
8. Zhang B, Liu S, Tan T, Huang W, Dong Y, Chen L, et al. Treatment with convalescent plasma for critically ill patients with SARS-CoV-2 infection. Chest [Internet]. 2020 Mar 31 [cited 2020 Apr 10]; Available from:
9. Cao B, Wang Y, Wen D, Liu W, Wang JJ, Fan G, et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020 Mar 18;
10. philippe Gautret, Jean-Christophe Lagier, Philippe Parola, Van Thuan Hoang, Line Meddeb, Jacques Sevestre , et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study.[pre-print]. avaliable to:
11. Zhang Z, Li X, Zhang W, Shi ZL, Zheng Z, Wang T. Clinical Features and Treatment of 2019-nCov Pneumonia Patients in Wuhan: Report of A Couple Cases. Virologica Sinica. Science Press; 2020.
12. Zheng F, Liao C, Fan Q, Chen H, Zhao X, Xie Z, et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci. 2020 Mar 24;
13. Leng Z, Zhu R, Hou W, Feng Y, Yang Y, Han Q, et al. Transplantation of ACE2- Mesenchymal Stem Cells Improves the Outcome of Patients with COVID-19 Pneumonia. Aging Dis. 2020;11(2):216.
14. Yuan J, Zou R, Zeng L, Kou S, Lan J, Li X, et al. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients. Inflamm Res. 2020;
15. Cao W, Liu X, Bai T, Fan H, Hong K, Song H, et al. High-dose intravenous immunoglobulin as a therapeutic option for deteriorating patients with Coronavirus Disease 2019. Open Forum Infect Dis. 2020 Mar 21;
16. Deng Z, Yuxing HU, Yang P, Zheng P, Peng W, Ren B, et al. Diagnosis and Treatment of an Acute Severe Pneumonia Patient with COVID-19: Case Report. J Med Virol [Internet]. 2020 Mar 30; Available from:
17. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical Features and Treatment of COVID-19 Patients in Northeast Chongqing. J Med Virol. 2020 Mar 21;
18. Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19). J Intern Med. 2020 Mar 27;
19. Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 Critically Ill Patients with COVID-19 with Convalescent Plasma. JAMA - J Am Med Assoc. 2020;
20. Chen S, Yin Q, Shi H, Du D, Chang S, Ni L, et al. A familial cluster, including a kidney transplant recipient, of Coronavirus Disease 2019 (COVID-19) in Wuhan, China. Am J Transplant. 2020;
21. Zhu L, Xu X, Ma K, Yang J, Guan H, Chen S, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020;0–3.
22. Bin L, Yangzhong W, Yuanyuan Z, Huibo S, Fanjun Z, Zhishui C. Successful Treatment of Severe COVID-19 Pneumonia in a Liver Transplant Recipient. Am J Transplant [Internet]. 2020 Apr 3 [cited 2020 Apr 10]; Available from:
23. Lim J, Jeon S, Shin HY, Kim MJ, Seong YM, Lee WJ, et al. Case of the index patient who caused tertiary transmission of coronavirus disease 2019 in Korea: The application of lopinavir/ritonavir for the treatment of COVID-19 pneumonia monitored by quantitative RT-PCR. J Korean Med Sci. 2020 Feb 17;35(6).
24. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929–36.
25. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med [Internet]. 2020;8(4):420–2. Available from:
26. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 Mar 17;323(11):1061–9.
27. Chen Q, Quan B, Li X, Gao G, Zheng W, Zhang J, et al. A report of clinical diagnosis and treatment of nine cases of coronavirus disease 2019. J Med Virol. 2020 Mar 16;
28. Zhang K. Is traditional Chinese medicine useful in the treatment of COVID-19? Am J Emerg Med. 2020 Mar;

29. A. N, A. T, E. W. Long QT and hydroxychloroquine; a poorly recognised problem in rheumatology patients. Arthritis Rheum [Internet]. 2013;65(table 1):S872. Available from:
30. Jia W, Gao W. Is Traditional Chinese Medicine Useful in the Treatment of SARS ? 2003;841:840–1.
How to Cite
Hussain M, Haider A, Yousaf U, Laraib W, Dildar F, Hussain H. Comparison of effectiveness of various treatment strategies in COVID-19 patients: A Systematic Review. JRMC [Internet]. 5Aug.2020 [cited 16Aug.2022];24(Supp-1):108-17. Available from:

Most read articles by the same author(s)