Despite aggressive efforts on containment measures for the coronavirus disease 2019 (COVID-19) pandemic around the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously spreading. Therefore, there is an urgent need for an effective antiviral agent. To date, considerable research has been conducted to develop different approaches to COVID-19 therapy. In addition to early observational studies, which could be limited by study design, small sample size, non-randomized design, or different timings of treatment, an increasing number of randomized controlled trials (RCTs) investigating the clinical efficacy and safety of antiviral agents are being carried out. This study reviews the updated findings of RCTs regarding the clinical efficacy of eight antiviral agents against COVID-19, including remdesivir, lopinavir/ritonavir, favipiravir, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, baloxavir, umifenovir, darunavir/cobicistat, and their combinations. Treatment with remdesivir could accelerate clinical improvement; however, it lacked additional survival benefits. Moreover, 5-day regimen of remdesivir might show adequate effectiveness in patients with mild to moderate COVID-19. Favipiravir was only marginally effective regarding clinical improvement and virological assessment based on the results of small RCTs. The present evidence suggests that sofosbuvir/daclatasvir may improve survival and clinical outcomes in patients with COVID-19. However, the sample sizes for analysis were relatively small, and all studies were exclusively conducted in Iran. Further larger RCTs in other countries are warranted to support these findings. In contrast, the present findings of limited RCTs did not indicate the use of lopinavir/ritonavir, sofosbuvir/ledipasvir, baloxavir, umifenovir, and darunavir/cobicistat in the treatment of patients hospitalized for COVID-19.

尽管世界各地为遏制 2019 年冠状病毒病 (COVID-19) 大流行采取了积极的措施，但严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 仍在持续传播。因此，迫切需要一种有效的抗病毒剂。迄今为止，已经进行了大量研究来开发不同的 COVID-19 治疗方法。除了早期观察性研究（可能受到研究设计、小样本量、非随机设计或不同治疗时间的限制）之外，越来越多的随机对照试验（RCT）调查抗病毒药物的临床疗效和安全性。正在进行中。本研究回顾了关于八种抗病毒药物针对 COVID-19 的临床疗效的随机对照试验的最新结果，包括瑞德西韦、洛匹那韦/利托那韦、法匹拉韦、索磷布韦/达拉他韦、索磷布韦/雷迪帕韦、巴洛沙韦、乌非诺韦、达芦那韦/考比司他及其组合。瑞德西韦治疗可以加速临床改善；然而，它缺乏额外的生存益处。此外，瑞德西韦的 5 天治疗方案可能对轻度至中度 COVID-19 患者显示出足够的有效性。根据小型随机对照试验的结果，法匹拉韦在临床改善和病毒学评估方面仅略微有效。目前的证据表明，索磷布韦/达拉他韦可以改善 COVID-19 患者的生存率和临床结果。然而，分析的样本量相对较小，而且所有研究都专门在伊朗进行。有必要在其他国家进行更大规模的随机对照试验来支持这些发现。相比之下，目前有限的随机对照试验结果并未表明洛匹那韦/利托那韦、索磷布韦/雷迪帕韦、巴洛沙韦、乌非诺韦和达芦那韦/考比司他在治疗因 COVID-19 住院的患者中的使用。