RT Journal Article
SR Electronic
T1 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
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E734
OP E744
DO 10.1503/cmaj.200647
VO 192
IS 27
A1 Liu, Wei
A1 Zhou, Pengxiang
A1 Chen, Ken
A1 Ye, Zhikang
A1 Liu, Fang
A1 Li, Xiaotong
A1 He, Na
A1 Wu, Ziyang
A1 Zhang, Qi
A1 Gong, Xuepeng
A1 Tang, Qiyu
A1 Du, Xin
A1 Ying, Yingqiu
A1 Xu, Xiaohan
A1 Zhang, Yahui
A1 Liu, Jinyu
A1 Li, Yun
A1 Shen, Ning
A1 Couban, Rachel J.
A1 Ibrahim, Quazi I.
A1 Guyatt, Gordon
A1 Zhai, Suodi
YR 2020
UL http://www.cmaj.ca/content/192/27/E734.abstract
AB 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.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.200648