Abstract
Background: To better inform clinical practice, we summarized the findings from randomized controlled trials (RCTs) of antivirals for COVID-19.
Methods: We systematically searched for literature up to September 2020, and included English-language publications of RCTs among hospitalized COVID-19 patients. We conducted network meta-analysis combining results of both the direct and indirect comparisons of interventions. The efficacy outcomes were clinical progression, all-cause mortality, and viral clearance, and safety outcomes were diarrhea, nausea, and vomiting. We generated treatment rankings (best to worst) and summarized rank probabilities using rankogram.
Results: We included 15 RCTs (14,418 patients) from 7,237 retrieved citations. There was no evidence for efficacy of the assessed antivirals compared with placebo/no treatment or with another antiviral for all efficacy outcomes. Lopinavir (400 mg)/ritonavir (100 mg) significantly increased diarrhea, nausea, and vomiting compared with placebo/no treatment and other antivirals, and was ranked worst for these outcomes, while triazavirin (250 mg), baloxavir marboxil (80 mg), and remdesivir (100 mg – 10 days) ranked best, respectively.
Conclusions and relevance: The available evidence does not support the use of any antiviral drugs for COVID-19. Cautious interpretations of the findings are, however, advised considering the paucity of the evidence. More RCTs are needed for a stronger evidence base.
Keywords: Antiviral drugs; COVID-19; efficacy; network meta-analysis; randomized controlled trials; safety; systematic review.
【저자키워드】 COVID-19, Efficacy, Randomized controlled trials, Safety, antiviral drugs, Network meta-analysis, systematic review., 【초록키워드】 Randomized controlled trial, Treatment, Randomized controlled trials, Antiviral, antivirals, antiviral drugs, Lopinavir, Ritonavir, Network meta-analysis, Remdesivir, systematic review, progression, outcome, diarrhea, RCT, viral clearance, antiviral drug, outcomes, Probability, Randomized, Viral, controlled trials, comparison, Interpretation, Placebo, patients, Clinical practice, RCTs, Evidence, baloxavir marboxil, best, baloxavir, Support, triazavirin, hospitalized COVID-19 patients, all-cause mortality, nausea, vomiting, significantly increased, conducted, searched, retrieved, 【제목키워드】 coronavirus disease, antiviral drugs, drug,