Article type
Year
Abstract
Background: The COVID-19 outbreak presents a new, life-threatening disease. Data and evidence on the effectiveness and safety of antiviral agents for patients with COVID-19 are limited.
Objectives: To assess the potential effectiveness and safety of antiviral agents for COVID-19 patients.
Methods: Electronic databases from January, 2002 to March, 29 2020 was searched for randomized controlled trials, quasi-randomized clinical trials and cohort studies of interventions with antiviral agents for patients (adult and children) with COVID-19.
Results: A total of 25 studies with 6124 patients were included after screening of 2879 titles and abstracts and 80 full-text articles. The risks of bias in all studies were moderate to high in general. There is no evidence showing the effectiveness and safety of antiviral therapy for children with COVID-19. Evidence of very low to low-quality suggested that the effectiveness and safety of existing antiviral agents for adult patients with COVID-19 is uncertain: lopinavir/ritonavir had no effect on mortality (risk ratio [RR]= 0.77, 95% confidence interval [CI] 0.45 to 1.30) and probability of negative PCR test (RR=0.98, 95 CI% 0.82 to 1.18). Arbidol had no benefit on probability of negative PCR test (RR=1.27, 95% CI 0.93 to 1.73). Hydroxychloroquine was significantly associated with increased probability of negative PCR result (RR=5.60, 95% CI 1.48 to 21.13). For other antiviral agents, we included indirect evidence of SARS and MERS, and evidence of very low to low-quality suggested interferon could reduce corticosteroid dose (weighted mean difference [WMD]=-0.14 g, 95% CI -0.21 to -0.07) but with no effect on mortality (RR=0.72, 95% CI 0.28 to 1.88); ribavirin did not reduce mortality (RR=0.68, 95% CI % 0.43 to 1.06) and was associated with high risk of severe adverse reactions; oseltamivir had no effect on mortality (RR=0.87, 95% CI 0.55 to 1.38) in adults with SARS. While ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions. We will update the results as new evidence emerging and provide living evidence to the related stakeholders.
Conclusions: The effectiveness and safety of existing antiviral agents for patients with COVID-19 is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 (with the exception of clinical trials).
Patient or healthcare consumer involvement: None
Objectives: To assess the potential effectiveness and safety of antiviral agents for COVID-19 patients.
Methods: Electronic databases from January, 2002 to March, 29 2020 was searched for randomized controlled trials, quasi-randomized clinical trials and cohort studies of interventions with antiviral agents for patients (adult and children) with COVID-19.
Results: A total of 25 studies with 6124 patients were included after screening of 2879 titles and abstracts and 80 full-text articles. The risks of bias in all studies were moderate to high in general. There is no evidence showing the effectiveness and safety of antiviral therapy for children with COVID-19. Evidence of very low to low-quality suggested that the effectiveness and safety of existing antiviral agents for adult patients with COVID-19 is uncertain: lopinavir/ritonavir had no effect on mortality (risk ratio [RR]= 0.77, 95% confidence interval [CI] 0.45 to 1.30) and probability of negative PCR test (RR=0.98, 95 CI% 0.82 to 1.18). Arbidol had no benefit on probability of negative PCR test (RR=1.27, 95% CI 0.93 to 1.73). Hydroxychloroquine was significantly associated with increased probability of negative PCR result (RR=5.60, 95% CI 1.48 to 21.13). For other antiviral agents, we included indirect evidence of SARS and MERS, and evidence of very low to low-quality suggested interferon could reduce corticosteroid dose (weighted mean difference [WMD]=-0.14 g, 95% CI -0.21 to -0.07) but with no effect on mortality (RR=0.72, 95% CI 0.28 to 1.88); ribavirin did not reduce mortality (RR=0.68, 95% CI % 0.43 to 1.06) and was associated with high risk of severe adverse reactions; oseltamivir had no effect on mortality (RR=0.87, 95% CI 0.55 to 1.38) in adults with SARS. While ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions. We will update the results as new evidence emerging and provide living evidence to the related stakeholders.
Conclusions: The effectiveness and safety of existing antiviral agents for patients with COVID-19 is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 (with the exception of clinical trials).
Patient or healthcare consumer involvement: None