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Antiviral drugs for coronavirus disease 2019 (COVID-19): a systematic review with network meta-analysis

George N Okoli1, Rasheda Rabbani1,2, Amenah Al-Juboori1

  • 1George & Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Expert Review of Anti-Infective Therapy
|July 29, 2021
PubMed
Abstract

Insights

Current antiviral drugs show no proven efficacy for treating COVID-19 patients. Further randomized controlled trials are necessary to establish a stronger evidence base for antiviral therapies in clinical practice.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Medicine

Background:

  • COVID-19 treatment guidelines require evidence-based antiviral drug recommendations.
  • Randomized controlled trials (RCTs) are crucial for evaluating antiviral efficacy and safety.

Purpose of the Study:

  • To systematically summarize RCT findings on antiviral treatments for COVID-19.
  • To inform clinical practice by assessing the efficacy and safety of various antiviral drugs.

Main Methods:

  • Systematic literature search up to September 2020 for English-language RCTs in hospitalized COVID-19 patients.
  • Network meta-analysis to compare direct and indirect treatment effects.
  • Efficacy outcomes included clinical progression, mortality, and viral clearance; safety outcomes included gastrointestinal adverse events.

Main Results:

  • Fifteen RCTs involving 14,418 patients were analyzed.
  • No assessed antiviral demonstrated efficacy over placebo or other antivirals for any outcome.
  • Lopinavir/ritonavir increased adverse gastrointestinal events and was ranked worst; triazavirin, baloxavir marboxil, and remdesivir were ranked best for safety.

Conclusions:

  • Current evidence does not support the use of any antiviral drugs for COVID-19.
  • Findings should be interpreted cautiously due to limited evidence.
  • Additional RCTs are required to build a robust evidence base for antiviral therapies.
Keywords:
Antiviral drugsCOVID-19efficacynetwork meta-analysisrandomized controlled trialssafetysystematic review

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