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Updated: 3 hours 38 min ago

The world must learn from pandemic lessons to avoid future catastrophes. Millions of lives could be saved through increased use of evidence.

Wed, 10/13/2021 - 15:59

Hundreds of health leaders and experts meet today to recommend the international community urgently mount stronger evidence-based responses to global health emergencies.

Led by Cochrane, co-sponsored by the World Health Organization (WHO), and co-organized with partners of COVID-END (COVID-19 Evidence Network to support Decision-making), Cochrane Convenes brings together leaders in health care and evidence synthesis to discuss the global healthcare challenges created by COVID-19.

COVID-19 created a once-in-a-generation focus on health evidence for governments, businesses and non-governmental organizations as well as many types of professionals and the public. The pandemic fast-tracked collaboration among decision-makers and researchers but also laid bare shortfalls in the systems of producing and sharing evidence.

Introducing Cochrane Convenes today, WHO Director-General Dr Tedros Adhanom Ghebreyesus said,

“During the COVID-19 pandemic, WHO’s Science Division has worked closely with the Health Emergencies Programme to produce and quality-assure more than one thousand six hundred guidance documents. This would not have been possible without our partnership with Cochrane, the partners of the COVID-END network, and our WHO Evidence Collaborative for COVID-19.”

Watch the full welcome message from Dr Adhanom Ghebreyesus on the Cochrane Convenes website

The recommendations and learning from Cochrane Convenes will form an action plan to advocate for change across the global health evidence community including those who produce evidence, share health messages and those who use evidence to make decisions in policy and practice. Participants include scientists, researchers, funders, public health decision makers and practitioners, patient and consumer advocates as well as health and science editors.

The recommendations include:

  •  The pandemic evidence response has been weighted towards high-income countries. Funders should invest more in research carried out by low and middle-income countries, support training and communication needs, and address the inequity in what is funded
  •  Building expertise in conveying uncertainty about what is known and not known during a health emergency
  • Stronger connections are needed across sectors; this involves building and incentivising institutions, partnerships and networks to be better prepared for future emergencies

Leading WHO’s involvement in Cochrane Convenes, Dr. John Grove, WHO Director of Quality Assurance, Norms and Standards explained,

“As a community of evidence producers and users we had a huge amount to take stock of. We needed to harvest what we’ve learned and Cochrane Convenes has given us the opportunity to start this. It has come out loud and clear that we need to remain connected as a community around our aim to shore up good practice in evidence production and use - for the good of all our health across the world.

Promisingly, the participants have shown the collective will exists to get us fit for purpose and now we need to move towards putting these recommendations into action.”

Cochrane’s Editor in Chief, Dr Karla Soares-Weiser said:

“Cochrane’s unique perspective placed us well to host these strategic discussions and we’ve been pleased to see a global community of evidence producers and users come together. We know we need to support the World Health Organization and its member states with the best possible evidence and guidance to ensure that local decision-makers and frontline healthcare professionals have the most trusted, high-quality evidence and information they need – but the question has been how to improve and do this better.”

She added, “What we have learned today is that the focus lies not only in maintaining the rigour of the science but also investing in our global networks and partnerships. We need to build a system we can all trust, that caters for all users of evidence wherever they are in the world.”

A summary of recommendations will inform an action plan due out later this year and will be used to advocate for change ensuring better preparedness for future global health emergencies.

Thursday, October 14, 2021

Cochrane launches new focus on diversity and inclusion

Mon, 10/11/2021 - 10:20

Cochrane wants to welcome people, no matter who they are or where they live. The more varied perspectives we have, the better we can provide evidence to help inform health and healthcare decisions.
 
We have contributors, supporters and members from all over the world, but we know very little about our community and what is important to you. This is an opportunity to learn from our community and hear your ideas about how Cochrane can become a more diverse and inclusive organisation.
 
We’ve launched a survey and are also running small online meetings. You can take part by:

  1. completing the short survey here now.  It only takes a few minutes. You don’t need to give your name
  2. AND letting us know if you are interested in attending a small group meeting to talk about your experiences of diversity and inclusion in Cochrane. If you are interested sign up here to stay informed.

We want to hear from you whether you are involved a lot in Cochrane or not much at all.  Your feedback will help to create a Diversity and Inclusion Strategy in 2022.
 
Chris Champion, Head of People Services, says

“Cochrane is a worldwide organisation that aspires to be diverse and inclusive. We want everyone to be able to participate in Cochrane, regardless of who they are and where they come from. This matters to Cochrane, because if we are more inclusive, we will be able to provide better and more relevant evidence to our users who are at the heart of our vision.”

If you want to know more about this work then please contact Chris Champion, cchampion@cochrane.org.

Friday, October 15, 2021

Author Q&A: Ketamine as a treatment for depression

Thu, 10/07/2021 - 14:01

In this interview with Doctoral Researcher Rebecca Dean and Professor Andrea Cipriani we learn more about two reviews investigating the use of ketamine as a treatment for depression recently published through Cochrane’s Common Mental Disorders Group.

Tell us about this Cochrane Review
This review is an update of a Cochrane review published in 2015, investigating the use of ketamine and other glutamate receptor modulators as a treatment for unipolar depression (also known as major depressive disorder).

Since 2015, a lot of research has been published in this area and the FDA has recently licensed esketamine (Spravato) for use in treatment resistant depression, so we realised it was time to update the review with the most recent evidence.

And we understand you recently published Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. How do these reviews complement each other?
Both reviews look at the use of ketamine and other glutamate receptor modulators in the treatment of depression, but they are reviewed separately as these drugs may work differently according to diagnosis.

What can we learn about the role of ketamine in treating depressive disorders because of these studies?
Ketamine and esketamine may be effective in the short-term at reducing symptoms of depression for people with unipolar depression. Both of these drugs can cause side effects, which may be a consideration for treatment.

For depression in bipolar disorder, we did not find data on esketamine, but ketamine was efficacious in reducing depressive symptoms, again only in the short-term. There was no difference in side effects between ketamine and placebo for people with bipolar disorder, but this was based on very limited evidence.

There was no evidence that any other glutamate receptor modulators that we included in these reviews (such as memantine, lanicemine, and N-acetylcysteine) were more effective in treating depression over placebo in either unipolar depression or bipolar disorder.



Is there a strong message for people with depressive disorders, clinicians or policy makers?
Ketamine (and possibly esketamine) can be used to treat depression, however there wasn’t enough certainty in the evidence to be able to take away a strong message, as there were many limitations in the data available.

Further research needs to focus on the long-term effects of ketamine and other glutamate receptor modulators, so we can have enough evidence to assess whether these drugs are good at treating depression over longer periods of time and what the side effects are.

We also need more trials to compare ketamine and other glutamate receptor modulators with active drugs (not just placebo), so we can compare them and know whether they are better than current treatments for depressive symptoms.

With more evidence in a future update of this review, we hope we will be able to make stronger conclusions that can reliably inform policy and practice.

Are there any more Cochrane reviews planned on this topic OR do you plan to update these reviews in the future?
We will update these reviews as more evidence becomes available to help us better understand the role of ketamine and other glutamate receptor modulators in depressive disorders in future. There is a need for effective treatments for mood disorders, supported by robust evidence and implemented in the NHS.

Monday, October 11, 2021

Cochrane UK seeks Public Health Consultant, Oxford UK

Tue, 10/05/2021 - 14:37

Cochrane UK is seeking a dynamic, self-motivated, public health consultant with an interest in evidence-based practice to work with us one day per week. You should be on the GMC/GDC Specialist Register or the UK Public Health (Specialist) Register and be an accredited educational supervisor for public health trainees. The role can be offered as a secondment from your current employer or on a consultancy contract. 

 

You will join the small friendly team at Cochrane UK, supporting the global work of Cochrane and maximizing the use and impact of Cochrane Reviews for the UK and Ireland. You will provide expert public health advice and leadership on a range of public health issues relevant to Cochrane UK and lead on the development of links between Cochrane UK and National Public Health NHS bodies. You will play an active role in teaching and training, developing current initiatives, and supervising public health trainees and trainees in medical specialities on placement at Cochrane UK.

Download the job description and person specification (word doc).

If you would like more information, please contact Therese Docherty, Business & Programme Manager therese.docherty@cochrane.nhs.uk. Our Director, Martin Burton, is happy to discuss the role with interested candidates.

 

To apply for this post, please send a covering letter and CV to therese.docherty@cochrane.nhs.uk

Closing date 1st November 2021.

Interviews will be held virtually on the afternoon of 11th November.

Tuesday, October 5, 2021 Category: Jobs

NICE seeks Technical Analyst - Manchester, UK

Fri, 10/01/2021 - 20:42

Job Type: Fixed term (12 months),  Full time
Specialty/Function: Technical Analyst
Employer: National Institute for Health and Care Excellence
Department: Centre for Guidelines
Location: Manchester, UK
Salary: £40,057 - £45,839 per annum
Closing Date: 17/10/2021

The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice on promoting high quality health, public health and social care.

We are looking for a Technical Analyst to support the organisation through a period of dynamic transformation.

Reporting to the Research associate – Strategic Engagement, the Technical Analyst will be a key member of the team responsible for establishing and building on existing collaborative partnerships with external organisations to facilitate the delivery of efficient and sustainable systems and processes to enable the delivery of dynamic, living guideline recommendations.

The post holder should be able to demonstrate the following:

  • Advanced theoretical and practical knowledge of a range of work procedures and practices related to process and methodology for evidence synthesis in guidelines or health services research
  • Understanding of the principles of evidence-based health care, critical appraisal and the interpretation and synthesis of health care research evidence
  • Ability to think and plan strategically and to exercise sound judgement in the face of conflicting pressures
  • An understanding of the social, political, economic and technological context in which the NHS and the Institute operates
  • Ability to establish effective working relationships with a range of professionals both within and outside the Institute
  • Effective and persuasive communicator demonstrating oral, written and presentation skills with a high degree of personal credibility and sensitivity

Learn more and apply before 17 October

Friday, October 1, 2021

Celebrating the UN International Day of Older Persons 2021

Fri, 10/01/2021 - 12:54

Cochrane Global Ageing: “Let's build an evidence-based world for all ages.”

The UN International Day of Older Persons (IDOP), this year October 1, 2021, is a special date that marks the United Nations (UN) recognition of the opportunities and challenges of population ageing in the 21st century. A day when we can celebrate increases in life expectancy and raise awareness of the need for action to ensure good health in older ages. The year 2021 also marks the beginning of the UN Decade of Healthy Ageing, which is an unprecedented opportunity to foster healthy ageing and to promote the health, wellbeing, and quality of life of older adults around the world.

High-quality evidence is critical to ensure informed decision-making at all levels of societies, contributing to achieving the goals set for the decade.

We would like to join the celebration of this special day by sharing some of the high-quality evidence from the Cochrane Library and the Campbell Collaboration produced over the past twelve months. The COVID-19 pandemic remained a top priority, but relevant evidence was also produced regarding other several key topics for older adults.

We pledge to continue contributing to this global effort, whilst integrating a social and healthcare interdisciplinary perspective.

Happy International Day of Older Persons!

Acknowledgements: We would like to thank the authors and Review groups for producing the reviews in this blog. The image used on this blog  is from the Centre for Ageing Better free library of images. We would also like to thank the Centre for Ageing Better for creating this age positive resource. 

Blog written by Monserrat Conde, Director, Cochrane Global Ageing. 

Friday, October 1, 2021

NICE seeks Research associate - Manchester, UK

Wed, 09/29/2021 - 23:43

Job Type: Fixed term (12 months),  Full time
Specialty/Function: Research associate – Strategic EngagementEmployer: National Institute for Health and Care Excellence
Department: Centre for Guidelines
Location: Manchester, UK
Salary: £54,764 - £63,862 per annum
Closing Date: 06/10/2021

The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice on promoting high quality health, public health and social care.

They are looking for a skilled Research Associate – Strategic Engagement to support the organisation. Reporting to the Senior Technical Adviser- Methods the Research associate – Strategic Engagement will be a key member of the team responsible establishing and building on existing collaborative partnerships with external organisations to facilitate the delivery of efficient and sustainable systems and processes to enable the delivery of dynamic, living guideline recommendations.

The post holder should be able to demonstrate the following:

  • Advanced theoretical and practical knowledge of a range of work procedures and practices related to process and methodology for evidence synthesis in guidelines or health services research
  • Extensive knowledge of the principles of evidence-based health care, critical appraisal and the assessment, synthesis and interpretation of health care research evidence
  • Ability to effectively plan and manage highly complex projects and deliver work of a high standard often against competing demands with tight timeframes and deadlines
  • An understanding of the social, political, economic and technological context in which the NHS and the Institute operates
  • Experience of working with a wide range of stakeholders, including stakeholders and academia in health, public health and social care
  • Excellent oral and written communication skills, including the ability to communicate complex ideas to a range of audiences and to generate trust and confidence in individuals at all levels both within and outside the organisation

Learn more and apply before 6 October 

Thursday, September 30, 2021 Category: Jobs

Cochrane Convenes: interview with John Grove

Wed, 09/29/2021 - 17:28

Cochrane Convenes will bring together key thought leaders from around the world to discuss the COVID-19 evidence response and develop recommendations to help prepare for and respond to future global health emergencies. Cochrane Convenes is co-sponsored by The World Health Organization.

In this interview, we talk to Dr. John Grove, Director of Quality Assurance, Norms and Standards at The WHO about Cochrane Convenes.

Why do you think it is important to hold Cochrane Convenes now?
I think at this point in the pandemic we have a huge amount of experience to take stock of. We have experienced an unprecedented historical event where we all needed to step in and do the best we could. Now we have a chance to see what we've learned and what we might harvest from that to inform future plans.

The World Health Organization, has joined Cochrane and COVID-END as co-sponsors of this initiative, tell us about your motivation for being involved?
At the start of the pandemic, we formed a very early partnership with COVID-END, and Cochrane called the Evidence Collaborative for COVID-19, hosted by WHO. The purpose was to get all of the partners working in the evidence retrieval and/or synthesis space to get together to share learnings and specifics about what we were all doing. This was also an opportunity for WHO to share our own priorities. As a result, we were able to engage more fully with the community and to leverage the various skills needed to feed right into the response that we were managing. I think we also helped to reduce waste and duplication of efforts.

The motivation for being involved in Cochrane Convenes is to continue that spirit of partnership beyond the pandemic response, and to solidify this way of working not only between the three entities, but with all of the partners doing this kind of work in the field. It is critical for all of us to leverage that expertise for future pandemics, and, put simply: it is also just good practice.



What do you hope will come from Cochrane Convenes?
The plan is for it to inform an action plan which is exactly what we need right now. We need very practical recommendations to come out of this event, that are actionable right away, but that will help build towards the future.

In operational terms this should be about ways of working, ways to share information, ways to leverage technology together and how as a community we can remain connected for the good of global health.

Moreover, I’m hoping for a continued commitment to stay in communication, for the WHO to continue to share priorities, and for the sharing of information in a way that engages all of the partners in this space.

Which challenges do you think are critical for the evidence community to address in this forum?
There are three things I can immediately think of:

  • How can this community better marshal itself in the fight against misinformation? This means getting good solid evidence to decision-makers in understandable formats they can use in an expedited fashion.
  • Secondly, to work more on the open science agenda, to continue to share information, and to promote the sharing of publications. We also need to be able to pull that material together across the community.
  • The third one, is how do we become ready for future emergencies, and have standard operating procedures that allow us to always be on standby?

Who would you like to see attending Cochrane Convenes?
I think first and foremost I’d like to see the emerging talent we have out there in the community attending and that must include bright professionals from lower and middle-income countries. I think we also need to be a lot more intentional about building networks in those countries.

I’d like to have those there who are a bit radical in their willingness to change course, those who are interested in a living approach towards evidence and harnessing technology to do this work more efficiently.

Also, those who design the products for policymakers, the ones that are actually being referenced in the political sphere. I’d like them to be in the room with us, helping us think through the best ways to get information out to people in a way that changes their behaviour.

And finally, policymakers themselves, who can bridge policy and science, to help build up their literacy in weighing up trustworthy, actionable evidence.

Wednesday, September 29, 2021

Featured review: Is exercise an effective therapy to treat long‐lasting low back pain?

Tue, 09/28/2021 - 09:52

In this interview with Jill Hayden we learn how this review, one of Cochrane’s largest reviews published to date, has led to new ways of working collaboratively and with an increased focus on research integrity. An ongoing update of this review will bring five related Cochrane reviews together into one.
 
You have just completed the Cochrane review of Exercise treatment for chronic low back pain. How is this Cochrane review different to others you’ve worked on?
The size of this review made it quite different from other systematic reviews that I have contributed to, with 249 included trials. The review was challenging and took several years to complete because of the number of trials. As with most teams conducting systematic reviews, we had limited funding available to support this research, so it was difficult to complete the review with numerous new eligible trials being published on the topic each year.

However, a benefit of a review this size is the ability to explore study features – we were able to conduct analyses and identify issues that would not have been possible in smaller, focused reviews.

The review also allowed us to reflect on issues of research waste, duplication of effort and more efficient evidence production. For example, we observed several smaller systematic reviews published on the same topic while we were working hard assessing and synthesizing the exact same trials. With these challenges and observations, we have proposed a new collaborative model of review. We are excited to have recently received funding from the Canadian Institutes of Health Research to pilot an update of the review using this approach, in collaboration with Cochrane. We are calling the model a ‘Network Systematic Review’.

Tell me more about the Network Systematic review model idea.
Our Cochrane review investigates the effectiveness of exercise treatments for chronic low back pain – a broad question that includes any type of exercise. We realized that there are several other Cochrane review teams who are conducting reviews of specific exercise types that fall directly under the broad ‘exercise review’. Plus, many overlapping reviews are published outside of Cochrane. Every team has been searching, screening, and extracting data from some of the exact same trials. Replication in science is important, but this seemed excessive… This duplication results in a lot of wasted time and energy in the low back pain evidence ecosystem.

With the network systematic review, we will work collaboratively on each of these review steps. Instead of small teams working in isolation, we will coordinate more than twenty international researchers to plan and conduct the reviews together.



What do you think this new proposed model could mean for Cochrane and how reviews are produced?
Cochrane infrastructure is perfectly arranged to facilitate this network systematic review approach; we feel very fortunate to be partnering with the Cochrane Musculoskeletal group on this initiative.

There are benefits of the collaborative review conduct (for example, multiple review teams challenging each other and reaching consensus on methods and interpretation), and also there are benefits of the outputs. The overarching review provides the ability to better describe and assess studies in the field, and also to conduct analyses such as comparing effectiveness of treatments with network meta-analyses. The more in-depth, focused sub-review topic investigations will provide evidence about clinically relevant questions.

We anticipate that this model will make it more feasible to keep evidence up to date, standardize review methods, and allow methods investigations, all while potentially streamlining editorial processes.

My vision, I know shared by others, will be that data from systematic reviews and the trials included in systematic reviews are accessible and maintained in a searchable format so that reviewers and guideline developers can build on past work and are not duplicating efforts unnecessarily with overlapping syntheses.

Within this review, you noticed duplicated data in two trials that led you to assess research integrity issues in a comprehensive way. How did you decide what trials to exclude from the review?
This is a great example of a benefit of our large Cochrane review. Due to the large number of included studies, we added a step in the review process to identify potential linked publications (multiple publications of the same trial) and duplicate data. During this check we identified the exact same results data reported in two otherwise unrelated studies, and we noticed apparent patterns of reporting in these trial reports and several other publications. These observations prompted our comprehensive investigation of trial research integrity and publication characteristics.

We took a step back and defined characteristics of trials that we thought may be related to the trustworthiness of the studies such as trial pre-registration, risk of bias, inadequate reporting, plagiarism, and presumed predatory publication.

In the end, our research integrity check led us to exclude 30 trials from the review, each of which we judged to have multiple integrity or publication concerns. We have described our detailed methods and these research integrity characteristics for all trials included in the review in a separate publication.

I am pleased to see Cochrane’s new problematic studies policy that addresses this issue. It is important that we better understand how to measure important integrity characteristics and use this to limit the impact of untrustworthy data in evidence syntheses.

Tuesday, September 28, 2021

90,000 records and still counting: Cochrane COVID-19 Study Register production is enabled by machine learning and Cochrane Crowd

Wed, 09/22/2021 - 20:28

The Cochrane COVID-19 Study Register is a freely-available, continually-updated, annotated reference collection of human primary studies on COVID-19. It launched on April 1, 2020 with 1146 records. After 18 months, the register has grown to nearly 80 times its original size and now includes over 90,000 validated COVID-19 study records! The register has contributed to 39 published Cochrane reviews and 189 non-Cochrane publications. 

Making an impact

The CEOsys evidence ecosystem for COVID-19 research is an association of 20 German university hospitals and partner organizations, whose goal it is to compile, summarize, and assess the certainty of results coming from scientific studies examining the most pressing questions about prevention, treatment, and consequences of COVID-19. Based on this evidence, the project creates recommendations for action. Systematic review producer and Cochrane review co-author, Ina Monsef, reflects on the Cochrane COVID-19 Study Register’s contribution to the CEOsys: 

The Cochrane COVID-19 Study Register is a primary source of evidence for reviews produced within the CEOsys project. Using this curated register saved the whole team time. Information specialists, methodologists, and clinicians - we all benefited from less information noise. The register contains all important primary sources. The ability to filter by study design allowed us to quickly select the relevant studies for each review question. Another helpful feature is the study type filter for platform trials which allowed us to find updated information about these important studies. Over the course of the COVID-19 pandemic, the Cochrane register has been a valuable tool to help us produce high-quality COVID-19 reviews rapidly.

-Ina Monsef, Information Specialist Cochrane Haematology, University Hospital of Cologne, CEOsys Study Identification Team

Citizen Science and Machine learning

To maintain its massive production volume, the Cochrane COVID-19 Study Register relies on innovations in machine learning and Cochrane’s citizen science platform, Cochrane Crowd. With colleagues from the EPPI-Centre, we implemented a study classifier in January to help reduce our screening workload by 25%. The process to develop the study classifier will be published shortly and is currently available as a Research Square preprint

Similar to the publishing processes used for the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane uses a combination of automated centralised searches, machine learning classifiers and Crowd assessments to build the Cochrane COVID-19 Study Register. Since launching the Cochrane Crowd task COVID Quest! in June 2020, volunteer contributors have made over 90,000 assessments to the register. 

Make your contribution to the Cochrane COVID-19 Study Register

To help us celebrate 100,000 assessments, please join us on World Evidence-Based Healthcare Day on October 20th for a 12 hour screening challenge in COVID Quest! (08:00-20:00 BST). Participate at any point during the challenge for a chance to win prizes. You can also contribute to COVID Quest! at any time - there are always studies waiting for you to screen and classify. Anyone can join Cochrane Crowd and every contribution helps. No previous experience is necessary!

Tuesday, September 28, 2021

Cochrane Heart seeks Information Specialist (Maternity cover)

Wed, 09/22/2021 - 15:07

UCL Department / Division: Institute of Health Informatics
Location of position: London
Grade: 7
Hours: Job Share
Hours per week (%FTE): 29.2 hours per week (80%FTE)
Salary (inclusive of London allowance): £36,770 - £44,388 per annum
Salary pro-rata for part time vacancies

Duties and Responsibilities
The Institute of Health Informatics (IHI) was established in August 2014 as part of the Faculty of Population Health Sciences (FPHS) within the UCL School of Life and Medical Sciences (SLMS).

At the UCL Institute of Health Informatics, we work to develop and evaluate data collecting systems and utilise the data produced. Central to our work are electronic health records (EHR), which offer unique opportunities for the advancement of medical research, quality of care, and outcomes.  This role is based within the editorial team of Cochrane Heart, one of 52 review groups publishing Cochrane reviews.

As an Information Specialist with Cochrane Heart  you will be expected to work closely with Cochrane  review authors in identifying studies for inclusion in their reviews, mainly by designing and running complex searches in major medical databases and providing editorial input on the conduct and reporting of search methods.

In this role you will:

  • Assist  review authors through the process of preparing and updating reviews for publication in the Cochrane Library
  • Provide comprehensive literature search services to Cochrane review authors, including the design of search strategies, running of searches and provision of results
  • Ensure that reference records comply with the Cochrane guidance on record formats
  • Contribute to reports and other editorial activities as and when required.

This is a fixed term post for 9 months to cover maternity leave.

Key Requirements

About you:

  • Experience of working for Cochrane and designing and running complex search strategies for/in medical databases and clinical trial registers
  • Qualification in Library/Information Science or equivalent experience
  • Careful, analytical and conscientious approach to work
  • Experience of editorial reviewing of search methods

If you believe you meet the requirements why not come and be part of this unique and exciting opportunity and be part of something where you feel included, valued and proud

Further Details

  • A job description can be accessed at the bottom of this page.
  • To apply for the vacancy please click on the ‘Apply Now’ button on this page
  • For an informal discussion please contact Dr Rui Bebiano Da Providencia E Costa (r.providencia@ucl.ac.uk)
  • For any queries regarding this advert or recruitment process please contact Anita Gorasia (a.gorasia@ucl.ac.uk)

The UCL Ways of Working for professional services supports colleagues to be successful and happy at UCL through sharing expectations around how we work – please see www.ucl.ac.uk/ways-of-working to find out more.

We particularly welcome applications from black and minority ethnic candidates as they are under-represented within UCL at this level.

We will consider applications to work on a part-time, flexible and job share basis wherever possible.

  • Closing Date: 12 Oct 2021
  • Latest time for the submission of applications: 23:59
  • Interview date: tbc

Our department holds an Athena SWAN Bronze award, in recognition of our commitment to advancing gender equality.

This appointment is subject to UCL Terms and Conditions of Service for Research and Support Staff.

Please use these links to find out more about UCL working life including the benefits we offer and UCL Terms and Conditions related to this job.

Wednesday, September 22, 2021 Category: Jobs

Resource prioritization in the COVID-19 pandemic era: Special Collection and Editorial

Tue, 09/21/2021 - 19:09

Cochrane Library Special Collections provide a round-up of up-to-date Cochrane evidence on a specific topic. This Special Collection provides examples of resource-intense interventions for which there is high or moderate certainty evidence that they confer clinically small or no effects, and for which there is some evidence of harm to patients.

The reviews included in this special Collection are particularly relevant to the COVID-19 pandemic, and should inform guideline, and policy developers, and decision makers planning health care, both during and after the pandemic. It was developed in collaboration with Cochrane Members from  Cochrane Argentina, Cochrane Chile, Cochrane Denmark,  Cochrane Methods, Cochrane Sustainable Healthcare, and Cochrane Sweden.

The contributors to the Special Collection have also published an accompanying editorial; 'Making wise choices about low-value healthcare in the COVID-19 pandemic.' They explain how the  COVID‐19 pandemic has underscored the need for reliable evidence to support treatment decisions and health policy, and dwindling public funding of health systems makes the need for evidence to identify and de‐implement ineffective interventions even more acute. They share that this is the first of a series of Special Collections that will focus on healthcare interventions shown to being ineffective, potentially harmful, or unproven.

Wednesday, September 22, 2021

Cochrane Convenes Plenary Session: register now!

Mon, 09/20/2021 - 16:06

Join world leaders of evidence synthesis to learn lessons from COVID-19 and shape responses to future health emergencies. 

Cochrane Convenes is an online event hosted by Cochrane, sponsored by WHO, and co-organised with COVID-END (COVID-19 Evidence Network to support Decision-making).

Drawing on experiences of the COVID-19 pandemic, the inaugural Cochrane Convenes will bring together leaders from across the world to explore and then recommend the changes needed in evidence synthesis to better prepare for and respond to future global health emergencies. An international Advisory Group and Steering Group are supporting the meeting.  

Free registrations are open now for the public plenary session Everyone welcome to join! 14th October 2021, 09:30 UTC (see in your timezone)

Plenary Speakers:

  • Dr Charu Kaushic, Scientific Director, CIHR Institute of Infection and Immunity; Chair, GloPID-R
  • More to be annouced soon

Co chaired by:

  • Dr Agnes Binagwaho - Vice Chancellor and co-founder, University of Global Equity, Rwanda
  • Dr John Grove -Director of the Quality Assurance, Norms and Standards Department, World Health Organization

You can actively take part in a live, interactive panel session or just listen-only to lessons learned from the evidence synthesis response to COVID-19, including the communication of uncertain and rapidly changing evidence, the engagement with users to support evidence-informed decision making, and the need for political collaboration with research. The session will be recorded and shared afterwards for those unable to make it to the live session. 

Monday, September 20, 2021

Ivermectin: Cochrane’s most talked about review so far, ever. Why?

Tue, 09/14/2021 - 11:08

In this author interview with Stephanie Weibel and Maria Popp, we find out more about their Cochrane review, Ivermectin for treating and preventing COVID-19. The review currently has an Altmetric Attention Score of more than 7000, which makes it the most talked-about review in the history of the Cochrane Library.

Briefly, what is Ivermectin?
Ivermectin is a medicine used to kill parasites, such as intestinal worms (helminths) in animals or scabies in humans. It is inexpensive and it is widely used in regions of the world where parasitic infestations are common, such as in parts of Asia and South America. Ivermectin has few unwanted effects at low doses.

Before the COVID-19 pandemic, some laboratory studies had shown that ivermectin could slow down the reproduction of some viruses, such as the dengue fever virus. In April 2020, similar laboratory tests suggested a weak effect on slowing reproduction of the virus that causes COVID-19, SARS-CoV-2. During 2020, more than 30 clinical studies were started to test ivermectin as a treatment for COVID-19 in humans. Several of the small, early studies have since completed. Some of these studies suggested higher survival rates with ivermectin. This led some advocacy groups to lobby for the widespread introduction of ivermectin in the fight against COVID-19 across the world. However, the true effect of ivermectin on COVID-19 is a matter of ongoing debate.

Tell us briefly what did your Cochrane review find?
We searched for randomized studies that investigated ivermectin to prevent or treat COVID-19 in humans. The studies had to compare ivermectin to placebo, no treatment, usual care or a treatment that was known to work to some extent for COVID-19. In studies that looked at treatment with ivermectin, people had to have laboratory-test confirmed COVID-19 and receive treatment in hospital or as outpatients. We excluded studies that compared ivermectin to medicines that we know do not work, such as hydroxychloroquine, or medicines that we don’t know to be effective against COVID-19.

We found one study for the prevention of COVID-19 that had recruited 156 people in Egypt. We found 13 studies for treatment of COVID-19 that included approximately 1500 people who had moderate COVID-19 and were being treated in hospital or mild COVID-19 and were being treated as outpatients. The studies used different doses of ivermectin and different durations of treatment. We also found 31 ongoing studies, and another 18 that are complete but not yet published or where we have asked the study authors for more information before we can decide whether to include them.

Our main finding is that there is no evidence to support the use of ivermectin either for preventing or treating COVID-19. Because of a lack of good-quality evidence, we do not know whether ivermectin administered in hospital or in an outpatient setting leads to more or fewer deaths after one month when compared with a placebo or usual care.



Further, we do not know whether it improves or worsens patients’ condition, increases or decreases unwanted side effects, or leads to more or fewer negative COVID-19 tests 7 days after treatment. Likewise, we do not know whether ivermectin prevents COVID-19 infection or reduces the number of deaths after high-risk exposure to the SARS-CoV-2 virus.

The current lack of good-quality evidence on the effects of ivermectin is because the studies that we found are mainly small, with limitations in their design, conduct and reporting. The current evidence does not support using ivermectin for treating or preventing COVID-19 outside of well-designed randomized clinical studies.

The review has an Altmetric Attention Score of more than 7000 and is currently the top scoring Cochrane review of all time by this measure.  Why do you think it has provoked so much interest?
The interest in this review presumably reflects the ongoing controversy around the benefit of ivermectin for COVID-19. Some advocacy groups have drawn premature conclusions from small, early trials that suggested large reductions in death. They continuously lobby for the widespread introduction of ivermectin across the world for COVID-19. Based on their advice, health officials and governments of several countries have recommended the use of ivermectin for COVID-19 treatment and prevention.

Other institutions, such as the World Health Organization and the European Medicines Agency, currently state that the evidence available does not support the use ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized studies. Since the work of Cochrane is internationally accepted and considered as independent and of the highest trustworthiness, many people have awaited the Cochrane review on ivermectin to get a clearer, unbiased picture of the current evidence.

We understand that some people are desperate for an inexpensive and widely available solution to the pandemic. This is especially true for health systems struggling to cope with low  vaccination rates and severely affected by third or fourth waves of infection. However, even in a health crisis it remains unethical to recommend the widespread use of a drug that has not been proven to be effective under controlled conditions.

Even with the best of intentions, the idea of prescribing a drug simply because it has not been shown to be ineffective goes against medicine’s guiding principle to ‘do no harm’. This principle should not be ignored, especially when so much ongoing research to address the question of benefit and harm for ivermectin is being carried out in this pandemic. The results from the available clinical studies carried out so far cannot confirm ivermectin’s widely advertised benefits. In other words, we don't know whether ivermectin is helpful or not in the fight against COVID-19. Every drug has harms. Without proven benefit, the weight of harm is even greater. Therefore, ivermectin should currently only be used and examined in randomized controlled studies.

Even with the best of intentions, the idea of prescribing a drug simply because it has not been shown to be ineffective goes against medicine’s guiding principle to ‘do no harm’.


There is strong regional interest in this review, why?
We can only suspect that the interest in any promising treatments or preventive measures will be stronger in regions where there is a new peak of infections. This interest may be stronger in countries with low vaccination rates or a large number of opponents to vaccination.

How has the review informed/helped with the debate about ivermectin as a treatment?
There is a lot of incorrect and misleading information available online about ivermectin. There are many meta-analyses and systematic reviews, some of which have shown extreme mortality benefits. However, unlike our Cochrane review, they have been more inclusive with regard to the studies that are available, and not been conducted using rigorous standards.

We set out to provide a reliable and unbiased summary of evidence for the work of clinical guideline committees and health officials. Before conducting this Cochrane review, we had no prior belief about whether ivermectin was effective , we simply wanted to ensure that clinicians, politicians, and the overall population could base decisions on the most current and trustworthy evidence available. By thoroughly examining and analysing the published studies, we showed that not all studies on which the ivermectin hype is based are actually suitable for investigating the effects of this medicine. Most of the eligible studies had flawed study designs and produced low-quality evidence. Based on this very small pool of limited-quality studies, we can only conclude that ivermectin cannot be considered a ‘miracle drug’ at this point. We hope that the information our review provides reaches clinical, scientific, policy and lay audiences so that they are aware of the uncertainty around the effects of ivermectin in COVID 19.

And what next?
We are continually following the progress of ongoing studies and searching for new study publications of ivermectin. We expect that the 31 ongoing studies and 18 awaiting classification will feature in future versions of this review. Currently, there is an urgent need for good-quality evidence based on randomized controlled studies with appropriate randomization procedures, comparability of study arms and, preferably, a double-blind design.

We are waiting until the accumulating evidence leads to a change in our conclusions before republishing the review. This could involve a change in the results or certainty (for example, the GRADE rating) of one or more prioritized outcomes, or new settings, populations, interventions, comparisons, or outcomes studied.

However, if we consider that there is a strong case for an updated review without an anticipated change to the strength of the evidence (for example, due to heightened interest in this from a policy-maker) we may consider updating the review. We are reviewing the review scope and methods monthly, or more frequently if appropriate, in light of potential changes in COVID-19 research, such as when additional comparisons, interventions, subgroups, outcomes, or new review methods become available.

Tuesday, September 14, 2021

Cochrane Convenes: interview with John Lavis

Fri, 09/10/2021 - 12:55

Cochrane Convenes will bring together key thought leaders from around the world to discuss the COVID-19 evidence response and develop recommendations to help prepare for and respond to future global health emergencies.

In this interview, we talk to John Lavis, a member of the Cochrane Convenes steering group, about what he hopes will come out of the event.

Why do you think reflection/an event of this type is important right now?
COVID-19 has created a once-in-a-generation focus on evidence among governments, businesses and non-governmental organizations, many types of professionals, and citizens. Their decisions have shaped the pandemic response and will shape responses to future societal challenges, including health emergencies. The pandemic fast-tracked collaboration among decision-makers and researchers, but drawing from a range of types of evidence to inform decision-making is not yet routine. Now is the time to systematize the aspects of using evidence that have gone well with the COVID-19 evidence response and address the many shortfalls.


 
What do you hope will come from the initiative (Cochrane Convenes?)
Cochrane Convenes will generate actionable insights for a range of key stakeholders who will be instrumental in making the changes that are needed based on what we’ve learned over the past 18 months. This includes evidence producers, intermediaries and users, as well as funding agencies as among others. Cochrane Convenes will also help Cochrane to strategically position itself in the new evidence ecosystem we need to make better fit-for-purpose.

Which challenges do you think is critical for the evidence community to address in this forum?
The list is long, and we’re describing these challenges and ways to address them in the draft exhibits which will form the report of the Global Commission on Evidence to Address Societal Challenges.


 
Drawing on the work of Philippe Ravaud and colleagues, some examples of issues particularly germane to those working on the evidence-supply side include: 1) achieving better global coordination of evidence communities; 2) maintaining the right mix of ‘living’ evidence syntheses; 3) giving greater attention to identifying harms arising from interventions as well as benefits; 4) improving the sharing and use of individual participant data to support more contextualized insights; 5) working towards the greater inclusion of representatives from all relevant evidence groups (which I return to below); 6) using machine learning and other approaches to become efficient and timely in our work; 7) improving our reporting about the gaps in and quality and transparency of primary studies.
 
If there was one burning issue you hope the attendees will address, discuss, solve and begin to plan a way forward for, what is it?
Building on the fifth point in my list, I think we’re at a critical juncture in starting to work collaboratively with the groups involved in the full array of forms in which decision-makers typically encounter evidence. This includes data analytics, modelling, evaluation, behavioural/implementation research, qualitative insights, guidelines, and technology assessment (and cost-effectiveness analysis). We’ve learned a lot during the COVID-19 pandemic about the new roles being played by modelers and other evidence groups in supporting decision-making. We need to find ways to ensure all groups play to their comparative advantages while working collaboratively on new types of integrative evidence products.


 
Who would you like to see in attendance, and why?
We really need to engage with key opinion leaders among all key stakeholders, which includes evidence producers, intermediaries and users, as well as funding agencies. The sooner we can get on the same page about the key actions needed to create a new evidence ecosystem that is better fit-for-purpose, the better for all of us. These opinion leaders will then be key in engaging others to road-test the proposed actions, adjust them as needed, and push for their implementation.

 

Monday, September 13, 2021

Cochrane Library Editorial - Anticholinergic drugs and dementia: time for transparency in the face of uncertainty

Wed, 09/08/2021 - 17:58

 Would you choose a treatment option that might increase your risk of developing dementia?

Anticholinergic drugs (which contract smooth muscle, reduce heart rate, dilate blood vessels, and increase bodily secretions) are commonly used in clinical practice for the management of many conditions affecting older adults - for example for urinary incontinence and for treating depression. As a consequence, the cumulative anticholinergic exposure for older people taking medications for multiple health conditions can be underestimated. The sum of this exposure is called anticholinergic burden (ACB). Some anticholinergic drug adverse effects are short‐term and obvious (e.g. dry mouth, constipation) whereas others may be insidious and irreversible – one such concern related to long‐term ACB is a possible contribution to cognitive decline and dementia.

In a new Cochrane Library Editorial, Henry Woodford and Jennifer M Stevenson share their thoughts on the problems with current research and areas that lead to uncertainty around the ACB causality and risks. Given the uncertainty around ACB they call for the reduction of exposure, through fully informed shared decision‐making when anticholinergic medications are initiated, and regular medication review for older people using drugs with anticholinergic.

 

Wednesday, September 8, 2021

Co-Chair Tracey Howe to present at launch of the UN Decade of Healthy Ageing Platform

Fri, 09/03/2021 - 20:06

Register for this event
Online event in English (repeated in French and Spanish on other dates)
7 September 2021
12:00-13:00 CEST (check time in your time zone)

Co-Chair of Cochrane’s Governing Board and Director of the Cochrane Campbell Global Ageing Partnership Tracey Howe will present at an online event on Tuesday, 7 September, Enabling Knowledge for Healthy Ageing: Launching the UN Decade of Healthy Ageing Platform. 

Tracey will speak at the event about knowledge sharing to foster healthy ageing, in the context of the launch of the online Platform for the UN Decade of Healthy Ageing. Of the event, Tracey said, “We are honoured to participate in this important event demonstrating how the Cochrane Campbell Global Ageing Partnership’s high-quality evidence contributes to decision making that fosters healthy ageing.”

All are invited to join to hear from a diverse array of speakers, which can be viewed here.  

Friday, September 3, 2021

Can non-pharmacological measures prevent or reduce Covid-19 (SARS-CoV-2) infections in long term care facilities?

Mon, 08/30/2021 - 19:18

A recently published Cochrane review explores what measures can be taken in long-term care facilities to prevent COVID-19 outbreaks.
 
Can non-medicinal measures prevent or reduce SARS-CoV-2 infections in long term care facilities?

Key messages

  • Non-medicinal measures (e.g. visiting restrictions or regular testing) may prevent SARS-CoV-2 infections (causing COVID-19 disease) in residents and staff in long term care facilities, but we have concerns about the reliability of the findings.
  • More high-quality studies on real-world experiences are needed, in particular.
  • More research is also needed on measures in facilities where most residents and staff are vaccinated, as well as regions other than North America and Europe.

What are non-medicinal measures?
Non-medicinal measures are ways of preventing or reducing disease without using medicine, such as vaccines. These include controlling people's movements and contacts, using personal protective equipment (PPE), or regular testing for infection.

SARS-CoV-2 is very infectious. Elderly or disabled people, who live in care homes (long-term care facilities), are vulnerable to infection because they live in close contact with other people, with carers and visitors entering and leaving the facility. Due to age and underlying health conditions, care home residents have an increased risk of becoming seriously ill with COVID-19 and dying from the disease.

What did we want to find out?
We wanted to find out how effective non-medicinal measures are in preventing residents and staff in long-term care facilities from becoming infected with SARS-CoV-2 and in reducing the spread of the infection. We focused on all types of long-term care facilities for adults, such as nursing homes for the elderly and skilled nursing facilities for people living with disabilities.



What did we do?
We searched for studies that investigated the effects of non-medicinal measures in long-term care facilities. To be included, studies had to report how many infections, hospitalisations or deaths the measures prevented in residents or staff, or whether the measures prevented the introduction of the virus into the facilities or prevented outbreaks within facilities. We included any type of study, including observational studies that used ‘real-world’ data, or modelling studies based on assumed data from computer-generated simulations.

What did we find?
We found 22 studies, 11 observational and 11 modelling studies. All studies were conducted in North America or Europe.

There were four main types of measures.

  1. Entry regulation measures to prevent residents, staff or visitors introducing the virus into the facility. Measures included staff confining themselves with residents, quarantine for newly-admitted residents, testing new admissions, not allowing the admission of new residents, and preventing visitors from entering facilities.
  2. Contact-regulating and transmission-reducing measures to prevent people passing on the virus. Measures included wearing masks or PPE, social distancing, extra cleaning, reducing contact between residents and among staff, and placing residents and staff in care groups and limiting contact between groups.
  3. Surveillance measures designed to identify an outbreak early. Measures included regular testing of residents or staff regardless of symptoms, and symptom-based testing.
  4. Outbreak control measures to reduce the consequences of an outbreak. Measures included isolation of infected residents, and separating infected and non-infected residents or staff caring for them.

Some studies used a combination of these measures.

Main results

Entry regulation measures (4 observational studies; 4 modelling studies)
Most studies showed that such measures were beneficial, but some studies found no effects or unwanted effects, such as depression and delirium among residents in the context of visiting restrictions.

Contact-regulating and transmission-reducing measures (6 observational studies; 2 modelling studies)
Some measures may be beneficial, but often the evidence is very uncertain.

Surveillance measures (2 observational studies; 6 modelling studies)
Routine testing of residents and staff may reduce the number of infections, hospitalisations and deaths among residents, although the evidence on the number of deaths among staff was less clear. Testing more often, getting test results faster, and using more accurate tests were predicted to have more beneficial effects.

Outbreak control measures (4 observational studies; 3 modelling studies)
These measures may reduce the number of infections and the risk of outbreaks in facilities, but often the evidence is very uncertain.

Combination measures (2 observational studies; 1 modelling study)
A combination of different measures may be effective in reducing the number of infections and deaths.

What are the limitations of the evidence?
Our confidence in these results is limited. Many studies used mathematical prediction rather than real-world data, and we cannot be confident that the model assumptions are accurate. Most observational studies did not use the most reliable methods. This means we cannot be confident that the measure caused the effect, for example, that testing of residents reduced the number of deaths.

How up to date is this evidence?
This review includes studies published up to 22 January 2021.
 
Dr. Jan M Stratil, first author of the review, said, “Measures to prevent outbreaks of COVID-19 in long-term care facilities, such as restrictions on visiting, wearing masks, regular testing, and isolation of suspected cases were assessed in this Cochrane review. We found that some of these measures may prevent SARS-CoV-2 infections and their consequences for residents and staff, though we have concerns about the reliability of the findings.

More high-quality studies on real-world experiences are needed, in particular in facilities with high vaccination rates, as well as from regions other than North America and Europe. Also, it should be explored why the topic of COVID-19 in long-term care facilities, despite the very high disease burden, received relative little attention by the research community.”

Wednesday, September 15, 2021

Cochrane Convenes: interview with Jeremy Grimshaw

Thu, 08/26/2021 - 17:21

Cochrane Convenes will bring together key thought leaders from around the world to discuss the COVID-19 evidence response and develop recommendations to help prepare for and respond to future global health emergencies.

In this interview, we talk to Jeremy Grimshaw, a member of the Cochrane Convenes steering group, about what he hopes will come out of the event.

Why do you think it is important to hold Cochrane Convenes now?

The COVID-19 pandemic has presented one of the greatest stress tests society has faced in a century. It has been a huge success for research in the way we have rapidly been able to understand the virus, how to address it and develop vaccines, but one challenge that arose during this very rapid period is that it has been hard for decision makers to make sense of the production of research. Evidence synthesis and systematic reviews are critical when the evidence base is evolving at speed.

COVID-19 has tested the evidence synthesis world and prompted innovation, methodological developments, improvements in producing rapid evidence syntheses and greater global collaboration. But it has also revealed fragility in the system: the challenge of co-ordination and duplication of effort, questionable quality in some systematic reviews, and the fact that evidence synthesis can become redundant quickly. We must address these challenges so that those involved in the production and use of evidence are better positioned in the future.

Cochrane Convenes offers a great opportunity to learn from the innovation and look at the weaknesses and tackle these as a global community of evidence producers and users.

Tell us about your involvement and the Global Commission on Evidence to Address Societal Challenges.

Shortly after the pandemic started, I was a co-lead of COVID-END, an umbrella network of over 50 evidence synthesis organisations which came together to encourage co-ordination and collaboration across the evidence community. We saw COVID-END as time limited and that capturing learnings and experiences over the course of the pandemic would have useful applications in the longer term.

In parallel to Cochrane Convenes, COVID-END has set up a Global Commission on Evidence to Address Societal Challenges. This independent commission draws on expertise in decision making from across the world, from health and non-health sectors with a few members from the evidence synthesis research community. Our aim is to create a high-level roadmap that will stimulate further development of the evidence system. Cochrane has been part of COVID-END from the start and we see the commission and Cochrane Convenes as parallel highly complementary activities.

We hope during the Cochrane Convenes meeting we can road test some of the ideas coming out of the commission.

What do you hope will come from Cochrane Convenes?

Cochrane’s leadership is important in this space because it is the preeminent evidence synthesis organisation. It made a fantastic contribution to the pandemic response, which has only furthered its position in the evidence community, so it is well placed to pull together a group to think about the implications not only for its work but also the broader evidence community. Cochrane Convenes is a powerful signal to kick off and accelerate the start of discussions and debates about what we as an evidence community need to do differently to improve the evidence response in ‘normal’ times, as well as when we are faced with a health emergency. It will also help inform Cochrane’s future strategy, which others will take note of.

Which challenges do you think are critical for the evidence community to address in this forum?

How we co-ordinate evidence synthesis is critical. Even before the pandemic, there was inappropriate duplication of systematic reviews and then gaps where there are none. We need to establish how there can be a global stock of preferably living systematic reviews that decision makers can draw on when they need to, managed through a co-ordinated flow of relevant and timely synthesis. This will raise issues about the conduct and timeliness of evidence synthesis which will prompt questions about infrastructure and securing funding for synthesis activities.

Healthcare systems, governments, clinicians and patients should see evidence as one of the key tools in helping them make informed decisions and start to incorporate evidence as a routine part of their decision making. We need prompts for decision makers to consider evidence in their processes and to reflect on how we provide evidence to the decision makers in friendly and understandable formats. This is about closing the gap between the producers and users of evidence. We need to ask how we support evidence intermediary organisations that can act as the link between suppliers of evidence and those who use it. There are pockets of excellence around the world and the ambition is to make this the norm so evidence always informs key decisions.

Who would you like to see in attendance, and why?

National, organisational, professional and citizen views are critical and the more of those views Cochrane Convenes can bring together the better. Cochrane is full of great science, but it needs to improve the conversations it has externally – and listen and understand other perspectives. Decision makers could also do better to understand how evidence syntheses can support what they are interested in.

This is an example of COVID enabling the convening of rooms in a way that would not have happened before. After the pandemic we have an opportunity to look at how global communities and societies function together and how evidence used in decision making will help us all maximise global goods and citizen wellbeing.

 

Monday, August 30, 2021

Are laboratory-made, COVID-19-specific monoclonal antibodies an effective treatment for COVID-19?

Wed, 08/25/2021 - 12:00

'SARS‐CoV‐2‐neutralising monoclonal antibodies for treatment of COVID‐19' from Cochrane Haematology  published today in the Cochrane Library. 

Key messages

  • We do not know whether antibodies (the body’s natural defence against disease) made in a laboratory and all the same as one another (monoclonal) and designed to target COVID-19, are an effective treatment for COVID-19 because we assessed only six studies exploring different treatments in different types of patients.
  • We identified 36 ongoing studies that will provide more evidence when completed.
  • We will update this review regularly as more evidence becomes available.

We spoke to Nina Kreuzberger, Research Associate, who explained this review to us:

“In the rush to treat COVID patients, treatments have been used that are not yet supported by mature data. SARS-CoV-2 neutralising monoclonal antibodies (mAbs) are being used and bought widely, although their value is still under question. Multiple monoclonal antibodies or antibody cocktails, such as bamlanivimab, bamlanivimab with etesevimab, casirivimab with imdevimab, sotrovimab, and regdanvimab, have been investigated in one study each.

In non-hospitalised patients, mAbs may reduce the rate of hospitalisation or death, but effects on mortality alone, adverse events, serious adverse events and quality of life are uncertain or vary per substance due to small sample sizes, or are completely lacking. Data on bamlanivimab in hospitalised patients show little to no effect on mortality and hospital discharge, but may increase the occurrence of adverse events. Similarly, casirivimab with imdevimab has probably no effect on mortality and hospital discharge, data on adverse effects are lacking. These studies suggest that it would be valuable to take a look at subgroups of patients based on serostatus. 

We know there are 36 ongoing studies and look forward to updating this review to get a clearer picture on the benefits of this treatment soon.”

What are ‘monoclonal’ antibodies?
Antibodies are made by the body as a defence against disease. However, they can also be produced in a laboratory from cells taken from people who have recovered from a disease.

Antibodies that are designed to target only one specific protein – in this case, a protein on the virus that causes COVID-19 – are ‘monoclonal’. They attach to the COVID-19 virus and stop it from entering and replicating in human cells, which helps to fight the infection. Monoclonal antibodies have been used successfully to treat other viruses. They are thought to cause fewer unwanted effects than convalescent plasma, which contains a variety of different antibodies.

What did we want to find out?
We wanted to know if COVID-19 specific monoclonal antibodies are an effective treatment for COVID-19. We looked at whether they:

  • reduced the number of deaths from any cause;
  • improved symptoms or made them worse;
  • increased admissions to hospital; and
  • caused any serious or other unwanted effects.

What did we do?
We searched for studies that investigated one or more monoclonal antibodies to treat people with confirmed COVID-19 compared with placebo (sham treatment), another treatment or no treatment. Studies could take place anywhere globally and include participants of any age, gender or ethnicity, with mild, moderate or severe COVID-19.

We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and size.

What did we find?
We found six active studies including a total of 17,495 people. Four studies investigated non-hospitalised people with no symptoms or mild COVID-19. Two studies investigated hospitalised people with moderate to severe COVID-19. Studies took place across the world. Three studies were funded by pharmaceutical companies. The monoclonal antibodies they studied were bamlanivimab, etesevimab, casirivimab and imdevimab, sotrovimab, regdanvimab. We did not identify data for mortality at 60 days and quality of life.

Non-hospitalised people, with no symptoms or mild COVID-19 (four studies)
One study investigated different doses of bamlanivimab (465 people), compared to placebo.

We don’t know whether bamlanivimab:

  • increases or reduces the number of deaths because no participants died within 30 days of treatment;
  • causes more or fewer serious unwanted effects because there were few events.

Bamlanivimab may reduce the number of admissions to hospital within 30 days of treatment compared to placebo.

  • May cause slightly fewer unwanted effects than placebo.
  • We did not find data for improved symptoms or worsened symptoms.

One study investigated a combination of bamlanivimab and etesevimab (1035 people), compared to placebo.

  • Bamlanivimab and etesevimab may reduce the number of deaths and admissions to hospital.
  • May cause slightly more unwanted effects.
  • May cause more serious unwanted effects.

For treatment with bamlanivimab alone or in combination with etesevimab we did not find data for improved symptoms or worsened symptoms.

One study (phase 1/2 with 799 people) investigated different doses of casirivimab combined with imdevimab, compared to placebo.

  • Casirivimab combined with imdevimab may reduce the number of hospital admissions or death.
  • We don't know whether casirivimab and imdevimab causes more unwanted (grades 3 and 4) and serious unwanted effects than placebo because there were too few deaths to allow us to make a judgment.
  • We did not find data for the number of people who died at day 30 and development of severe symptoms.
  • We did not include results from phase 3 (5607 people) of this study, because of high risk of bias, as it was not clear which participants were included in the analysis.

One study (583 people) investigated sotrovimab, compared to placebo.
We don't know whether sotrovimab:

  • increases or reduces the number of deaths and people requiring invasive mechanical ventilation or dying, because there were too few deaths to allow us to make a judgment.
  • Sotrovimab may reduce the number of people requiring oxygen, unwanted (grades 3 to 4) and serious unwanted effects;
  • may have little or no effect on unwanted effects (all grades).

Another study (327 people) investigated different doses of regdanvimab (40 mg/kg and 80 mg/kg), compared to placebo.

  • Regdanvimab at either dose may reduce the number of admissions to hospital or death.
  • May increase unwanted events (grades 3 to 4).
  • Regdanvimab at a dose of 80 mg/kg may reduce unwanted effects (all grades) and 40 mg/kg may have little to no effect.
  • We don't know whether regdanvimab increases or decreases the number of deaths, requirement for invasive mechanical ventilation, and serious unwanted effects,  because there were too few events to allow us to make a judgment.

Hospitalised people with moderate to severe COVID-19 (2 studies)
One study (314 people) investigated bamlanivimab compared to placebo.

  • We don’t know whether bamlanivimab increases or decreases the number of deaths due to any cause up to 30 or 90 days after treatment because there were too few deaths to allow us to make a judgment (6 deaths with bamlanivimab and 4 deaths with placebo in 314 people).
  • Bamlanivimab may slightly increase the development of severe COVID-19 symptoms five days after treatment and the number of people with unwanted effects.
  • Bamlanivimab may have little to no effect on time until discharge from hospital.
  • We don’t know whether bamlanivimab causes serious unwanted effects by day 30 because the study was small and reported few serious unwanted effects.

Another study (9785 people) investigated casirivimab combined with imdevimab, compared to standard of care.

  • Casirivimab combined with imdevimab has probably little to no effect on the number of deaths, requirement for invasive mechanical ventilation or death, and hospital discharge alive.
  • We did not find data for unwanted and serious unwanted effects.

What are the limitations of the evidence?
Our confidence in the evidence is low because we found only six studies, and they did not report everything we were interested in, such as the number of deaths within 60 days and quality of life. We found 36 ongoing studies. When they are published, we will add their results to our review. These results are likely to change our conclusions and will also help us understand how new variants affect how well monoclonal antibodies work.

How up to date is this evidence?
The evidence is up to date to 17 June 2021.

Thursday, September 2, 2021

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