Expert Rev Anti Infect Ther. 2021 Jul 29. doi: 10.1080/14787210.2021.1961579. Online ahead of print.
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 (400mg)/ritonavir (100mg) significantly increased diarrhea, nausea and vomiting compared with placebo/no treatment and other antivirals, and was ranked worst for these outcomes while triazavirin (250mg), baloxavir marboxil (80mg), and remdesivir (100mg - 10days) 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.