ABSTRACT

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 (400 mg)/ritonavir (100 mg) significantly increased diarrhea, nausea, and vomiting compared with placebo/no treatment and other antivirals, and was ranked worst for these outcomes, while triazavirin (250 mg), baloxavir marboxil (80 mg), and remdesivir (100 mg – 10 days) 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.

中文翻译：

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2019 年冠状病毒病 (COVID-19) 的抗病毒药物：通过网络荟萃分析进行的系统评价

摘要

背景

为了更好地为临床实践提供信息，我们总结了 COVID-19 抗病毒药物随机对照试验 (RCT) 的结果。

方法

我们系统地检索了截至 2020 年 9 月的文献，并纳入了住院 COVID-19 患者中 RCT 的英文出版物。我们结合干预措施的直接和间接比较结果进行了网络荟萃分析。疗效结果是临床进展、全因死亡率和病毒清除率，安全性结果是腹泻、恶心和呕吐。我们生成治疗排名（从最佳到最差）并使用排名图总结排名概率。

结果

我们从 7,237 条检索到的引文中纳入了 15 项 RCT（14,418 名患者）。与安慰剂/不治疗或另一种抗病毒药物相比，没有证据表明评估的抗病毒药物对所有疗效结果的疗效。与安慰剂/未治疗和其他抗病毒药物相比，洛匹那韦（400 毫克）/利托那韦（100 毫克）显着增加腹泻、恶心和呕吐，在这些结果中排名最差，而三氮唑核苷（250 毫克）、巴洛沙韦（80 毫克）和瑞德西韦（100 毫克 - 10 天）分别排名最高。

结论和相关性

现有证据不支持对 COVID-19 使用任何抗病毒药物。然而，考虑到证据的缺乏，建议对研究结果进行谨慎的解释。需要更多的随机对照试验来获得更强有力的证据基础。