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Meta-Analysis
. 2020 Jul 6;192(27):E734-E744.
doi: 10.1503/cmaj.200647. Epub 2020 Jun 3.

Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis

Wei Liu  1 , Pengxiang Zhou  1 , Ken Chen  1 , Zhikang Ye  1 , Fang Liu  1 , Xiaotong Li  1 , Na He  1 , Ziyang Wu  1 , Qi Zhang  1 , Xuepeng Gong  1 , Qiyu Tang  1 , Xin Du  1 , Yingqiu Ying  1 , Xiaohan Xu  1 , Yahui Zhang  1 , Jinyu Liu  1 , Yun Li  1 , Ning Shen  1 , Rachel J Couban  1 , Quazi I Ibrahim  1 , Gordon Guyatt  1 , Suodi Zhai  2
Affiliations
Meta-Analysis

Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis

Wei Liu et al. CMAJ. .

Abstract

Background: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19.

Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes.

Results: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting.

Interpretation: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.

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Conflict of interest statement

Competing interests: Ning Shen is an investigator in a clinical trial evaluating the effect of hydroxychloroquine in patients with coronavirus disease 2019 that is funded by the Peking University Health Science Center. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Flow chart for the determination of included studies. CNKI = China National Knowledge Infrastructure.
Figure 2:
Figure 2:
Risk-of-bias assessment for included randomized controlled trials. Note: References 15, 17, 18 and 28 are preprints.
See this image and copyright information in PMC

Comment in

  • CMAJ. 192:E536.

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