Objective To evaluate the efficacy and safety of antiviral antibody therapies and blood products for the treatment of novel coronavirus disease 2019 (covid-19). Design Living systematic review and network meta-analysis, with pairwise meta-analysis for outcomes with insufficient data. Data sources WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, and six Chinese databases (up to 21 July 2021). Study selection Trials randomising people with suspected, probable, or confirmed covid-19 to antiviral antibody therapies, blood products, or standard care or placebo. Paired reviewers determined eligibility of trials independently and in duplicate. Methods After duplicate data abstraction, we performed random effects bayesian meta-analysis, including network meta-analysis for outcomes with sufficient data. We assessed risk of bias using a modification of the Cochrane risk of bias 2.0 tool. The certainty of the evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We meta-analysed interventions with ≥100 patients randomised or ≥20 events per treatment arm. Results As of 21 July 2021, we identified 47 trials evaluating convalescent plasma (21 trials), intravenous immunoglobulin (IVIg) (5 trials), umbilical cord mesenchymal stem cells (5 trials), bamlanivimab (4 trials), casirivimab-imdevimab (4 trials), bamlanivimab-etesevimab (2 trials), control plasma (2 trials), peripheral blood non-haematopoietic enriched stem cells (2 trials), sotrovimab (1 trial), anti-SARS-CoV-2 IVIg (1 trial), therapeutic plasma exchange (1 trial), XAV-19 polyclonal antibody (1 trial), CT-P59 monoclonal antibody (1 trial) and INM005 polyclonal antibody (1 trial) for the treatment of covid-19. Patients with non-severe disease randomised to antiviral monoclonal antibodies had lower risk of hospitalisation than those who received placebo: casirivimab-imdevimab (odds ratio (OR) 0.29 (95% CI 0.17 to 0.47); risk difference (RD) −4.2%; moderate certainty), bamlanivimab (OR 0.24 (0.06 to 0.86); RD −4.1%; low certainty), bamlanivimab-etesevimab (OR 0.31 (0.11 to 0.81); RD −3.8%; low certainty), and sotrovimab (OR 0.17 (0.04 to 0.57); RD −4.8%; low certainty). They did not have an important impact on any other outcome. There was no notable difference between monoclonal antibodies. No other intervention had any meaningful effect on any outcome in patients with non-severe covid-19. No intervention, including antiviral antibodies, had an important impact on any outcome in patients with severe or critical covid-19, except casirivimab-imdevimab, which may reduce mortality in patients who are seronegative. Conclusion In patients with non-severe covid-19, casirivimab-imdevimab probably reduces hospitalisation; bamlanivimab-etesevimab, bamlanivimab, and sotrovimab may reduce hospitalisation. Convalescent plasma, IVIg, and other antibody and cellular interventions may not confer any meaningful benefit. Systematic review registration This review was not registered. The protocol established a priori is included as a data supplement. Funding This study was supported by the Canadian Institutes of Health Research (grant CIHR- IRSC:0579001321). Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Interim updates and additional study data will be posted on our website ([www.covid19lnma.com][1]). No additional data available. [1]: http://www.covid19lnma.com

中文翻译：

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用于治疗 covid-19 的抗体和细胞疗法：实时系统评价和网络荟萃分析

目的 评估抗病毒抗体疗法和血液制品治疗 2019 新型冠状病毒病（covid-19）的有效性和安全性。设计生活系统评价和网络荟萃分析，对数据不足的结果进行成对荟萃分析。数据来源 WHO covid-19 数据库、全球 covid-19 文献的综合多语言来源以及六个中文数据库（截至 2021 年 7 月 21 日）。研究选择 试验将疑似、可能或确诊的 covid-19 患者随机分组，接受抗病毒抗体疗法、血液制品或标准护理或安慰剂。配对评审员独立并一式两份地确定试验的资格。方法在重复数据提取后，我们进行了随机效应贝叶斯荟萃分析，包括对具有足够数据的结果进行网络荟萃分析。我们使用 Cochrane 偏倚风险 2.0 工具的修改版来评估偏倚风险。使用建议评估、制定和评估（GRADE）方法的分级来评估证据的确定性。我们对≥100名随机患者或每个治疗组≥20个事件的干预措施进行了荟萃分析。结果 截至 2021 年 7 月 21 日，我们确定了 47 项试验，评估恢复期血浆（21 项试验）、静脉注射免疫球蛋白 (IVIg)（5 项试验）、脐带间充质干细胞（5 项试验）、bamlanivimab（4 项试验）、casirivimab-imdevimab（4 项试验）试验）、bamlanivimab-etesevimab（2 项试验）、对照血浆（2 项试验）、外周血非造血富集干细胞（2 项试验）、sotrovimab（1 项试验）、抗 SARS-CoV-2 IVIg（1 项试验）、用于治疗 covid-19 的治疗性血浆置换（1 项试验）、XAV-19 多克隆抗体（1 项试验）、CT-P59 单克隆抗体（1 项试验）和 INM005 多克隆抗体（1 项试验）。随机接受抗病毒单克隆抗体治疗的非重症患者比接受安慰剂的患者住院风险更低：casirivimab-imdevimab（比值比 (OR) 0.29（95% CI 0.17 至 0.47）；风险差 (RD) -4.2%；中等确定性）、bamlanivimab（OR 0.24（0.06 至 0.86）；RD −4.1%；低确定性）、bamlanivimab-etesevimab（OR 0.31（0.11 至 0.81）；RD −3.8%；低确定性）和 sotrovimab（OR 0.17（ 0.04 至 0.57)；RD −4.8%；低确定性)。它们对任何其他结果没有产生重要影响。单克隆抗体之间没有显着差异。没有其他干预措施对非重症 covid-19 患者的任何结局产生任何有意义的影响。没有任何干预措施（包括抗病毒抗体）对重症或危重症 covid-19 患者的任何结局产生重要影响，但卡西瑞单抗-imdevimab 除外，该药物可能会降低血清阴性患者的死亡率。结论 在非重症 covid-19 患者中，casirivimab-imdevimab 可能会减少住院治疗；bamlanivimab-etesevimab、bamlanivimab 和 sotrovimab 可能会减少住院治疗。恢复期血浆、IVIg 以及其他抗体和细胞干预措施可能不会带来任何有意义的益处。系统评论注册 该评论未注册。先验建立的协议作为数据补充包含在内。资助 这项研究得到了加拿大健康研究所的支持（赠款 CIHR-IRSC：0579001321）。读者须知本文是一篇动态系统综述，将进行更新以反映新出现的证据。临时更新和其他研究数据将发布在我们的网站 ([www.covid19lnma.com][1]) 上。没有其他可用数据。[1]：http://www.covid19lnma.com