Universität zu Köln

Iannizzi, Claire ORCID: 0000-0002-6130-5997 (2024). Living systematic review methodology – application for pandemic preparedness based on experiences from the COVID-19 pandemic. PhD thesis, Universität zu Köln.

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Abstract

Background A living systematic review (LSR) is an emerging review type that incorporates continual updat-ing. During the COVID-19 pandemic, authors were confronted with a shifting epidemiological landscape, clinical uncertainties, and an evolving evidence base. These unexpected challenges compelled us to amend standard LSR methodology. Therefore, LSRs are most suitable for high-priority topics marked by substantial uncertainty and the ongoing publication of new evidence. Objective The primary objective of this cumulative dissertation was to explore the methodology of the novel review type, living systematic review, in the context of the Coronavirus disease 2019 (COVID-19) pandemic and to devise methods to respond to emerging challenges. The second-ary objective was to apply the explored methodology and conduct a living systematic review on a COVID-19 related topic. Methods This research involved a methodology concept paper, a scoping review and a Cochrane living systematic review: • Concept paper: A concept paper to explore and discuss the main challenges faced when conducting living systematic reviews during the COVID-19 pandemic, and to provide methodological guidance for similar future endeavours. • Scoping review: A scoping review to systematically provide a comprehensive overview of the available literature on guidance for conducting, reporting, publishing, and apprais-ing living systematic reviews. This aimed to identify areas of lacking evidence. • Living systematic review: A living systematic review with meta-analysis to assess the effectiveness and safety of convalescent plasma transfusion in treating people with COVID-19, using a living approach to ensure the inclusion of the latest evidence. Results Methodological results The concept paper on methodological challenges for LSRs underscored the suitability of the methodology for rapidly emerging diseases. It addresses challenges and considerations specific to LSRs, emphasising the potential need to continuously adapt eligibility criteria and the need for transparent reporting of these changes. Experiences during the COVID-19 pandemic highlight-ed that updating a LSR depends not solely on the evolving disease or emerging evidence, but also on the review question and the available financial resources. The scoping review systematically summarised available methodological guidance for conduct-ing, reporting, publishing, appraising LSRs. Identified evidence gaps, especially regarding re-porting and appraising quality of LSR, informed the development of a PRISMA 2020 extension for LSR. The methodological findings were applied in the fifth update version of a living systematic re-view on convalescent plasma treatment for people with COVID-19. Clinical results of the conducted living systematic review The results suggested that convalescent plasma transfusion does not reduce mortality and has little to no impact on clinical improvement or worsening when compared to standard of care alone, with or without placebo, for individuals with moderate to severe COVID-19. Evidence further suggested that the treatment probably has an impact on (serious) adverse events. Limited evidence exists on potential impacts on quality of life and for the comparison to standard plasma and to human immunoglobulin. The effects of convalescent plasma on individuals with mild COVID-19 and vulnerable patient groups (e.g. people with comorbidities or immunosuppres-sion) remain uncertain. Conclusion The doctoral projects addressed critical methodological considerations for LSRs conducted on a COVID-19 topic and suggested potential solutions, lessons learned, and implications for future research. Important gaps in LSR guidance were identified and systematically summarized in an evidence map to inform necessary updates. The application of LSR methods to a COVID-19 research topic endorsed key methodological findings. While highly suitable for a pandemic con-text of rapidly emerging diseases, stakeholders must consider the LSR specific features and adapt to arising challenges. Further research is needed for remaining questions, such as when to ‘retire’ and discontinue the updating of a LSR.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Iannizzi, Claire claire.iannizzi@uk-koeln.de orcid.org/0000-0002-6130-5997 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-727640
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Unspecified
Subjects:	Life sciences Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language COVID-19 UNSPECIFIED Pandemic Preparedness UNSPECIFIED Living systematic reviews UNSPECIFIED Pandemic UNSPECIFIED
Date of oral exam:	17 April 2024
Referee:	Name Academic Title Kalbe, Elke Prof. Dr. Köpke, Sascha Prof. Dr. Köberlein-Neu, Juliane Prof. Dr.
Funders:	CEOsys project (BMBF Grant Nr 01KX2021), „SUPPORT-E“ project: European Union's Horizon 2020 research and innovation programme
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/72764