Delivering rapid, up-to-date, high-quality evidence is feasible during health emergencies: PAHO living systematic review of 305 COVID-19 potential therapeutics.

Objective: To develop a living systematic review to deliver continuous, real-time evidence synthesis in the context of a rapidly evolving landscape of studies on potential therapeutic interventions during the COVID-19 pandemic. Methods: The living systematic review was conducted using the COVID-19 Living Overview of Evidence platform, which aggregates studies from more than 40 sources, including electronic databases and preprint servers. Daily searches identified randomized controlled trials assessing pharmacological interventions for COVID-19. Meta-analytical pooling was applied to derive precise effect estimates, and the GRADE framework was used to assess certainty. The iterative process ensured the continuous integration of new evidence and rapid updates to the review. Results: The review evaluated 305 interventions across 924 randomized controlled trials and included 48 updates from its launch in April 2020. This dynamic process allowed the team to respond promptly to decision-maker queries and deliver reliable information on intervention effectiveness and safety. The outputs of the review supported the development of therapeutic guidelines and informed decision-makers, playing a pivotal role in shaping clinical practices and public health strategies during the pandemic. Conclusions: The living systematic review approach demonstrated how dynamic evidence synthesis can meet the demands of a rapidly evolving global health crisis. By providing decision-makers with timely, high-quality evidence, the process underscored the importance of integrating living reviews into preparedness strategies for future public health emergencies or rapidly evolving fields where new evidence emerges quickly.