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Efficacy and safety of antivirals for Covid-19: A systematic review and meta-analysis
Manya Prasad1, Arunmozhimaran Elavarasi2, Karan Madan3
1Department of Community Medicine, North Delhi Municipal Medical College, New Delhi, India.
Background:
Coronavirus disease 2019 (Covid-19) has led to a severe medical, social and economic crisis globally. Use of antivirals has given inconsistent results; thus systematic summaries of available evidence are required for any recommendations for treatment. We conducted a systematic review and meta-analysis on the use of antivirals for Covid-19.
Methods:
The databases we searched were-Medline, Embase, Cochrane CENTRAL and Medrxiv. Title/abstract screening, full-text screening and data abstraction were carried out in duplicate by two researchers. Pooled effect sizes and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method of random effects for meta-analysis.
Results:
Twenty studies were found eligible for inclusion: 6 randomized controlled trials, 9 cohort studies and 5 case series. Moderate-quality evidence suggests a likely clinical benefit from the use of remdesivir in improving the number of recoveries (RR 1.18; 95% CI 1.07-1.31; I2 = 0%) and time to recovery in days (median -3.02; 95% CI -4.98 to -1.07; I2 = 97%). A possibility of lower mortality is suggested by low-quality evidence with remdesivir (RR 0.74; 95% CI 0.40-1.37, I2 = 58%). Moderate-quality evidence suggests no certain benefit of using lopinavir/ritonavir for Covid-19 compared to arbidol, lopinavir/ritonavir combined with arbidol or other medications used as controls.
Conclusion:
Further evidence from randomized controlled trials is required for all antivirals to treat Covid-19. At present, remdesivir seems more promising than other antivirals.
Insights
This systematic review found remdesivir may improve recovery for COVID-19 patients. More research is needed for other antivirals, but remdesivir shows the most promise for treating coronavirus disease 2019.
Area of Science:
- Infectious Diseases
- Virology
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) presents a global health and economic crisis.
- Antiviral treatments for COVID-19 have yielded inconsistent results.
- Systematic evidence summaries are crucial for guiding treatment recommendations.
Purpose of the Study:
- To conduct a systematic review and meta-analysis on the efficacy of antiviral agents for treating COVID-19.
- To synthesize current evidence on the clinical benefits of specific antivirals.
Main Methods:
- Searched Medline, Embase, Cochrane CENTRAL, and Medrxiv databases.
- Conducted duplicate title/abstract and full-text screening.
- Performed meta-analysis using random effects and the Mantel-Haenszel method to calculate pooled effect sizes and 95% confidence intervals (CI).
Main Results:
- Included 20 studies (6 RCTs, 9 cohort, 5 case series).
- Moderate-quality evidence suggests remdesivir likely improves recovery rates (RR 1.18; 95% CI 1.07-1.31) and shortens recovery time (median -3.02 days; 95% CI -4.98 to -1.07).
- Low-quality evidence suggests a possible reduction in mortality with remdesivir (RR 0.74; 95% CI 0.40-1.37), with no certain benefit for lopinavir/ritonavir.
Conclusions:
- Further randomized controlled trials are necessary for all antivirals used to treat COVID-19.
- Remdesivir currently appears more promising than other investigated antivirals.
- Evidence synthesis aids in understanding the current landscape of antiviral efficacy for COVID-19.
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