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76 aspirin COVID-19 controlled studies, 7 RCTs
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2+ ACTIV-4B Connors (DB RCT) 67% 0.33 [0.01-7.96] hosp. 0/144 1/136 Improvement, RR [CI] Treatment Control ACTIV-4B Connors (DB RCT) 19% 0.81 [0.28-2.35] progression 6/144 7/136 ACTIV-4B Connors (DB RCT) 6% 0.94 [0.06-15.0] progression 1/144 1/136 Alamdari -28% 1.28 [0.67-2.43] death 9/53 54/406 Husain 80% 0.20 [0.01-3.55] death 0/11 3/31 Husain 65% 0.35 [0.05-2.51] no recov. 1/11 8/31 Husain 96% 0.04 [0.00-0.64] progression 0/11 17/31 Goshua (PSM) 35% 0.65 [0.42-0.98] death 319 (n) 319 (n) Goshua (PSM) -49% 1.49 [1.03-2.18] ventilation 319 (n) 319 (n) Goshua (PSM) -45% 1.45 [1.06-1.98] ICU 319 (n) 319 (n) Meizlish (PSM) 48% 0.52 [0.34-0.81] death 319 (n) 319 (n) Liu (PSM) 75% 0.25 [0.07-0.87] death 2/28 11/204 Liu (PSM) 81% 0.19 [0.05-0.78] death 1/28 9/204 Liu (PSM) -2% 1.02 [0.64-1.61] viral time 24 (n) 24 (n) Mura (PSM) 15% 0.85 [0.69-1.01] death 527 (n) 527 (n) Mura (PSM) 37% 0.63 [0.47-0.83] death 305 (n) 305 (n) Chow 47% 0.53 [0.31-0.90] death 26/98 73/314 Chow 44% 0.56 [0.37-0.85] ventilation 35/98 152/314 Chow 43% 0.57 [0.38-0.85] ICU 38/98 160/314 Haji Aghajani 25% 0.75 [0.57-0.99] death 336 (n) 655 (n) Elhadi (ICU) 10% 0.90 [0.67-1.21] death 22/40 259/425 ICU patients Sahai (PSM) 13% 0.87 [0.56-1.34] death 33/248 38/248 Pourhoseingholi -32% 1.32 [1.02-1.71] death 71/290 268/2,178 Vahedian-Azimi 22% 0.78 [0.33-1.74] death 13/337 28/250 Vahedian-Azimi -10% 1.10 [0.68-1.68] ICU 36/337 44/250 Abdelwahab -8% 1.08 [0.15-3.82] ventilation 11/31 6/36 Karruli (ICU) 46% 0.54 [0.09-3.13] death 1/5 22/27 ICU patients Al Harthi (ICU) 27% 0.73 [0.56-0.97] death 98/176 107/173 ICU patients Al Harthi (ICU) 14% 0.86 [0.65-1.14] death 95/176 97/175 ICU patients Al Harthi (ICU) 5% 0.95 [0.80-1.12] ICU 176 (n) 175 (n) ICU patients Kim (PSM) 34% 0.66 [0.36-1.23] death 14/124 23/135 Kim (PSM) -102% 2.02 [0.83-4.90] ventilation 13/124 7/135 Kim (PSM) -91% 1.91 [0.57-6.35] ICU 7/124 4/135 Zhao 43% 0.57 [0.41-0.78] death 121/473 140/473 Zhao 28% 0.72 [0.54-0.96] death 473 (n) 1,597 (n) RECOVERY RECOVERY Co.. (RCT) 4% 0.96 [0.89-1.04] death 7,351 (n) 7,541 (n) RECOVERY RECOVERY Co.. (RCT) 17% 0.83 [0.66-1.04] death 7,351 (n) 7,541 (n) RECOVERY RECOVERY Co.. (RCT) 5% 0.95 [0.87-1.05] ventilation 7,351 (n) 7,541 (n) RECOVERY RECOVERY Co.. (RCT) 6% 0.94 [0.91-0.98] no disch. 7,351 (n) 7,541 (n) RECOVERY RECOVERY Co.. (RCT) 16% 0.84 [0.71-0.99] no disch. 7,351 (n) 7,541 (n) Mustafa 44% 0.56 [0.21-1.51] death 4/66 41/378 REMAP-CAP Bradbury (RCT) 16% 0.84 [0.70-1.00] death 165/563 170/521 REMAP-CAP Bradbury (RCT) 17% 0.83 [0.67-1.02] no disch. 161/563 167/521 REMAP-CAP Bradbury (RCT) 21% 0.79 [0.65-0.96] progression 204/563 212/521 REMAP-CAP Bradbury (RCT) 5% 0.95 [0.77-1.18] progression 563 (n) 521 (n) Chow (PSW) 13% 0.87 [0.81-0.93] death population-based cohort Santoro (PSM) 38% 0.62 [0.42-0.92] death 360 (n) 2,949 (n) RESIST Ghati (RCT) 22% 0.78 [0.31-1.98] death 11/442 7/219 RESIST Ghati (RCT) 58% 0.42 [0.11-1.62] death 3/221 7/219 RESIST Ghati (RCT) 9% 0.91 [0.34-2.42] ventilation 11/442 6/219 RESIST Ghati (RCT) 50% 0.50 [0.13-1.96] ventilation 3/221 6/219 RESIST Ghati (RCT) 30% 0.70 [0.27-1.81] progression 11/442 7/219 RESIST Ghati (RCT) 60% 0.40 [0.10-1.54] progression 3/221 7/219 Karimpour-Razke.. -123% 2.23 [1.26-3.38] death 39/90 64/363 ACT inpatient Eikelboom (RCT) -5% 1.05 [0.86-1.28] death 193/1,063 186/1,056 CT1 ACT inpatient Eikelboom (RCT) 8% 0.92 [0.78-1.09] progression 281/1,063 300/1,056 CT1 ACT inpatient Eikelboom (RCT) 11% 0.89 [0.73-1.09] progression 191/1,063 210/1,056 CT1 ACT outpatient Eikelboom (RCT) -9% 1.09 [0.48-2.46] death 12/1,945 11/1,936 ACT outpatient Eikelboom (RCT) 20% 0.80 [0.57-1.13] progression 59/1,945 73/1,936 ACT outpatient Eikelboom (RCT) 17% 0.83 [0.58-1.19] hosp. 56/1,945 67/1,936 Ali (ICU) 40% 0.60 [0.51-0.72] death 152/660 202/530 ICU patients Ali (ICU) 37% 0.63 [0.47-0.83] ARDS 74/660 95/530 ICU patients Aidouni (ICU) 31% 0.69 [0.54-0.88] death 202/712 165/412 ICU patients Aidouni (ICU) 10% 0.90 [0.74-1.10] ventilation 189/712 121/412 ICU patients Singla (RCT) 57% 0.43 [0.04-3.27] death 3/49 5/49 CT1 Singla (RCT) 15% 0.85 [0.11-6.31] death 49 (n) 49 (n) CT1 Singla (RCT) 20% 0.80 [0.23-2.80] ventilation 4/49 5/49 CT1 Singla (RCT) 29% 0.71 [0.24-2.10] ICU 5/49 7/49 CT1 Singla (RCT) 33% 0.67 [0.20-2.22] progression 4/49 6/49 CT1 Singla (RCT) 76% 0.24 [0.02-2.10] progression 4/49 7/49 CT1 Singla (RCT) 44% 0.56 [0.20-1.54] progression 5/49 9/49 CT1 Singla (RCT) 86% 0.14 [0.01-2.69] progression 0/49 3/49 CT1 Singla (RCT) 25% 0.75 [0.35-1.62] progression 9/49 12/49 CT1 Shamsi 96% 0.04 [0.00-7.20] death 0/13 24/170 Mehrizi 16% 0.84 [0.82-0.86] death population-based cohort Lewandowski -70% 1.70 [1.08-2.70] death 430 (all patients) Vinod 14% 0.86 [0.48-1.52] death 128 (n) 248 (n) Vinod 30% 0.70 [0.38-1.27] ventilation 128 (n) 248 (n) Vinod 40% 0.60 [0.36-1.00] progression 128 (n) 248 (n) Vinod -6% 1.06 [0.53-2.13] misc. 128 (n) 248 (n) Vinod 18% 0.82 [0.24-2.78] progression 128 (n) 248 (n) Azimi Pirsaraei -97% 1.97 [1.28-3.04] death 28/184 50/647 Holt -34% 1.34 [0.98-1.84] death/ICU 35/116 129/573 Wang 58% 0.42 [0.01-1.98] death 1/9 13/49 Lodigiani -21% 1.21 [0.73-2.01] ICU 17/94 44/294 Yuan 4% 0.96 [0.47-1.72] death 11/52 29/131 Ramos-Rincón -29% 1.29 [1.05-1.51] death 132/264 253/526 Osborne (PSM) 59% 0.41 [0.35-0.48] death 272/6,300 661/6,300 Osborne (PSM) 60% 0.40 [0.33-0.48] death 170/6,814 427/6,814 Merzon 28% 0.72 [0.53-0.99] cases 73/1,621 589/8,856 Merzon 62% 0.38 [0.02-4.94] death 1/21 6/91 Merzon 10% 0.90 [0.82-1.00] viral time 73 (n) 589 (n) Merzon 15% 0.85 [0.76-0.95] viral time 73 (n) 589 (n) Bejan 1% 0.99 [0.61-1.63] ventilation 1,899 (n) 7,330 (n) Mulhem -14% 1.14 [0.93-1.40] death 300/1,354 216/1,865 Reese (PSM) -61% 1.61 [1.31-1.99] death 4,921 (n) 4,921 (n) Reese (PSM) -309% 4.09 [3.72-4.50] severe case 4,921 (n) 4,921 (n) Drew 22% 0.78 [0.49-1.24] progression n/a n/a Drew -3% 1.03 [0.83-1.28] cases n/a n/a Pan -13% 1.13 [0.70-1.82] death 239 (n) 523 (n) Pan -2% 1.02 [0.66-1.57] death/int. 239 (n) 523 (n) Oh 1% 0.99 [0.65-1.50] death n/a n/a Oh 12% 0.88 [0.79-0.99] cases n/a n/a Son (PSM) 11% 0.89 [0.53-1.47] death case control Son (PSM) 24% 0.76 [0.34-1.71] death case control Son (PSM) -7% 1.07 [0.65-1.75] progression case control Son (PSM) 9% 0.91 [0.64-1.29] progression case control Son (PSM) -11% 1.11 [0.94-1.30] cases case control Son (PSM) -1% 1.01 [0.88-1.16] cases case control Ma (PSM) 9% 0.91 [0.82-1.02] death Ma (PSM) 2% 0.98 [0.92-1.04] hosp. Ma (PSM) -9% 1.09 [0.96-1.25] symp. case Ma (PSM) -7% 1.07 [0.99-1.16] cases Chow (PSM) 19% 0.81 [0.76-0.87] death 1,280/6,781 2,271/10,566 Chow (PSM) 3% 0.97 [0.93-1.02] ventilation 2,122/6,781 3,403/10,566 Kim (PSM) -700% 8.00 [1.07-59.6] death 6/15 1/20 Kim (PSM) -433% 5.33 [0.66-43.0] ventilation 4/15 1/20 Kim (PSM) -433% 5.33 [0.66-43.0] ICU 4/15 1/20 Kim (PSM) 33% 0.67 [0.30-1.36] cases 15/136 20/136 Kim (PSM) 34% 0.66 [0.36-1.23] death 14/124 23/135 Kim (PSM) -102% 2.02 [0.83-4.90] ventilation 13/124 7/135 Kim (PSM) -91% 1.91 [0.57-6.35] ICU 7/124 4/135 Basheer -13% 1.13 [1.05-1.21] death 45/140 29/250 Sisinni -7% 1.07 [0.89-1.29] death 93/253 251/731 Sisinni 30% 0.70 [0.53-0.92] death/int. 253 (n) 731 (n) Pérez-Segura -49% 1.49 [1.20-1.80] death 66/155 183/608 Formiga (PSM) -3% 1.03 [0.94-1.13] death 1,000/3,291 874/2,885 Formiga (PSM) -3% 1.03 [0.85-1.25] ventilation 213/3,291 181/2,885 Formiga (PSM) -4% 1.04 [0.88-1.23] ICU 283/3,291 238/2,885 Sullerot (PSW) -10% 1.10 [0.81-1.49] death 101/301 224/746 Sullerot (PSW) -110% 2.10 [1.21-3.64] ICU 22/301 26/746 Sullerot (PSW) -10% 1.10 [1.01-1.20] hosp. time 301 (n) 746 (n) Monserrat .. (PSM) -31% 1.31 [1.01-1.71] death n/a n/a Levy 26% 0.74 [0.49-1.10] death/hosp. 29/159 178/690 Nimer 4% 0.96 [0.69-1.33] hosp. 83/427 136/1,721 Nimer -18% 1.18 [0.87-1.56] severe case 98/427 162/1,721 Gogtay -6% 1.06 [0.51-1.89] death 12/38 21/87 Gogtay 50% 0.50 [0.18-1.22] ventilation 5/38 21/87 Gogtay 49% 0.51 [0.06-1.46] ICU 9/38 38/87 Campbell (PSW) 3% 0.97 [0.95-1.00] death 419 (n) 20,311 (n) Campbell (PSW) 2% 0.98 [0.95-1.00] death 419 (n) 20,311 (n) Lal 11% 0.89 [0.82-0.97] death 4,691 (n) 16,888 (n) Lal 22% 0.78 [0.73-0.84] ICU 4,691 (n) 16,888 (n) Lal 9% 0.91 [0.84-0.99] progression 4,691 (n) 16,888 (n) Botton -4% 1.04 [0.98-1.10] death/int. population-based cohort Botton -3% 1.03 [1.00-1.06] hosp. population-based cohort Malik 14% 0.86 [0.39-1.80] death 15/87 24/223 Malik 28% 0.72 [0.44-1.11] ICU 28/87 77/223 Malik 25% 0.75 [0.38-1.39] ARDS 13/87 40/223 Malik 2% 0.98 [0.53-1.78] hosp. 25 (n) 176 (n) Abul 33% 0.67 [0.47-0.95] death 46/511 201/1,176 Abul 40% 0.60 [0.40-0.90] death 33/511 154/1,176 Abul 20% 0.80 [0.60-1.07] hosp. 103/511 352/1,176 Loucera 18% 0.82 [0.74-0.92] death 2,127 (n) 13,841 (n) Morrison (PSM) 8% 0.92 [0.73-1.18] death 1,667 (n) 1,667 (n) Morrison (PSM) -1% 1.01 [0.71-1.43] ventilation 1,667 (n) 1,667 (n) Morrison (PSM) -12% 1.12 [0.88-1.43] ICU 1,667 (n) 1,667 (n) Morrison (PSM) -18% 1.18 [1.00-1.39] hosp. 1,667 (n) 1,667 (n) Ali 28% 0.72 [0.51-1.03] death 481 (n) 1,164 (n) Zadeh 37% 0.63 [0.30-1.29] death n/a n/a Zadeh -1% 1.01 [0.89-1.15] ICU n/a n/a Azizi 0% 1.00 [0.53-1.87] death 17/131 17/131 Aweimer -10% 1.10 [0.90-1.34] death 34/44 74/105 Intubated patients Tse (PSM) 67% 0.33 [0.18-0.59] death/int. 2,664 (all patients) Prieto-Campo -13% 1.13 [0.86-1.48] death case control Prieto-Campo 3% 0.97 [0.86-1.09] hosp. case control Prieto-Campo 0% 1.00 [0.87-1.15] progression case control Prieto-Campo 8% 0.92 [0.86-0.98] cases case control Ware (PSM) 46% 0.54 [0.53-0.56] death population-based cohort Sakamaki -37% 1.37 [1.31-1.44] severe case population-based cohort Aspirin COVID-19 outcomes c19 earlyOctober 2024 1 CT: study uses combined treatment Favors aspirin Favors control
Figure S2. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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