Introduction
As the COVID-19 pandemic spread across the globe, the need for up-to-date evidence-based medical guidance became critically important. Policymakers, healthcare professionals, and researchers grappled with rapidly evolving information regarding the effectiveness of various treatments, including convalescent plasma and systemic corticosteroids. This highlighted the value of living systematic reviews (LSRs), which are frequently updated to include the latest evidence. An article recently published in the “Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen” by Carina C. Wagner, Caroline C. Hirsch, Waldemar W. Siemens, Philipp P. Kapp, and Claire C. Iannizzi presents an experience report on the challenges faced while conducting two Cochrane LSRs during the height of the pandemic.
The Experience Report
The report, titled “Experience report of two living systematic Cochrane reviews on COVID-19,” DOI 10.1016/j.zefq.2023.11.004, details the complexities encountered during the LSRs of COVID-19 treatments. This encompassing task was managed by a team including experts from the Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cochrane Germany Foundation, and the Institute for Evidence in Medicine for the Medical Center – University of Freiburg. In their report, the researchers outline the adaptive nature of LSRs, a methodology designed for synthesizing research where evidence is rapidly evolving and emerging.
Methodology
LSRs are a type of systematic review that is updated continuously as new data becomes available. This process is designed to provide up-to-date evidence to inform decision-making in healthcare. The article by Wagner et al. delves into the unique challenges faced while conducting LSRs on convalescent plasma and systemic corticosteroids as treatments for COVID-19.
Challenges Faced
Among the significant hurdles were issues related to study design, publication types, intervention/comparator categorization, outcomes, search strategy, review updates, and the transparent reporting of differences between review updates. For the LSR on convalescent plasma, the scarcity of randomized controlled trial (RCT) data early in the pandemic required the inclusion of different study designs. In contrast, by the time the corticosteroids LSR was initiated, RCT data were available, allowing for a more traditional systematic review approach.
The researchers utilized caution when including preprints, recognizing the necessity of non-peer-reviewed data during a public health emergency, yet being wary of its unverified nature. The unavailability of a standard of care in the early stages of the pandemic posed a challenge in defining an intervention/comparator. Additionally, the emergence of SARS-CoV-2 variants required constant updates to the reviews.
The criteria for updating the LSRs were decided based on the importance of new studies, resource availability, and policy relevance. The team faced the task of continuously refining the outcome sets to keep pace with the evolving pandemic and the multiple updates to the literature search.
Despite these challenges, Wagner et al. found that the similarities and differences encountered provided insights that are valuable for future LSR authors and applicable in instances where new evidence emerges rapidly.
Keywords
1. COVID-19 Living Systematic Reviews
2. Convalescent Plasma Treatment
3. Systemic Corticosteroids COVID-19
4. Evidence-Based Healthcare
5. Cochrane Reviews Pandemic
Conclusion
The COVID-19 pandemic underscored the significance of updating and maintaining robust clinical treatment guidelines through methodologies such as living systematic reviews. Wagner et al.’s experience report serves as a testament to the adaptability and resilience of evidence-based medicine in times of crisis. Moreover, it offers practical guidance for future LSRs, suggesting that similar challenges can be expected in other rapidly progressing medical research areas.
This article grants healthcare practitioners, policymakers, and researchers insights into the robustness of living systematic reviews and the determination required to ensure that guidance remains relevant and reliable through dynamic times.
References
Wagner, C. C., Hirsch, C. C., Siemens, W. W., Kapp, P. P., & Iannizzi, C. C. (2024). Experience report of two living systematic Cochrane reviews on COVID-19. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, S1865-9217(23)00215-5. https://doi.org/10.1016/j.zefq.2023.11.004