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. 2022 Jan 31;22(1):107.
doi: 10.1186/s12879-022-07068-0.

Efficacy of antiviral therapies for COVID-19: a systematic review of randomized controlled trials

Charan Thej Reddy Vegivinti  1 , Kirk W Evanson  2 , Hannah Lyons  3   4 , Izzet Akosman  3   5 , Averi Barrett  3 , Nicole Hardy  3 , Bernadette Kane  2 , Praneeth Reddy Keesari  6 , Yashwitha Sai Pulakurthi  6 , Erin Sheffels  7 , Prasanth Balasubramanian  1 , Richa Chibbar  8 , Spandana Chittajallu  9 , Kathryn Cowie  3 , J Karon  3 , Lauren Siegel  3 , Ranita Tarchand  3 , Caleb Zinn  3 , Nitin Gupta  10   11 , Kevin M Kallmes  3 , Kavitha Saravu  10   11 , Jillienne Touchette  2
Affiliations

Efficacy of antiviral therapies for COVID-19: a systematic review of randomized controlled trials

Charan Thej Reddy Vegivinti et al. BMC Infect Dis. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to public health worldwide. The purpose of this study was to review current evidence obtained from randomized clinical trials on the efficacy of antivirals for COVID-19 treatment.

Methods: A systematic literature search was performed using PubMed to identify randomized controlled trials published up to September 4, 2021 that examined the efficacy of antivirals for COVID-19 treatment. Studies that were not randomized controlled trials or that did not include treatment of COVID-19 with approved antivirals were excluded. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) method. Due to study heterogeneity, inferential statistics were not performed and data were expressed as descriptive statistics.

Results: Of the 2,284 articles retrieved, 31 (12,440 patients) articles were included. Overall, antivirals were more effective when administered early in the disease course. No antiviral treatment demonstrated efficacy at reducing COVID-19 mortality. Sofosbuvir/daclatasvir results suggested clinical improvement, although statistical power was low. Remdesivir exhibited efficacy in reducing time to recovery, but results were inconsistent across trials.

Conclusions: Although select antivirals have exhibited efficacy to improve clinical outcomes in COVID-19 patients, none demonstrated efficacy in reducing mortality. Larger RCTs are needed to conclusively establish efficacy.

Keywords: Antiviral; COVID-19; Randomized controlled trial; SARS-CoV-2; Systematic review; Therapeutic.

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Conflict of interest statement

JT is CEO and has ownership interest in Superior Medical Experts. ES and BK are employed by Superior Medical Experts. KE performed work on this project as an employee of Superior Medical Experts. KK is CEO of Nested Knowledge, Inc., has ownership interest in Nested Knowledge, Inc. and Superior Medical Experts, and consults for Medtronic. KC is employed by and has equity in Nested Knowledge. IZ, AB, CZ, NH, JK, HL, LS, and RT are employed by Nested Knowledge, Inc.

Figures

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Fig. 1
PRISMA flowchart for study inclusion
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