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

Charan Thej Reddy Vegivinti,Bernadette Kane,Richa Chibbar,Averi Barrett,Erin Sheffels,Kathryn Cowie,Nitin Gupta,Nicole Hardy,Prasanth Balasubramanian,Ranita Tarchand,H A Lyons ,Izzet Akosman,Kirk W Evanson,Caleb Zinn,Praneeth Reddy Keesari,Lauren Siegel,John M Karon ,Spandana Chittajallu,Yashwitha Sai Pulakurthi,Kavitha Saravu,Kevin M Kallmes,Jillienne C Touchette

doi:10.1186/s12879-022-07068-0

Abstract

BackgroundCoronavirus 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.MethodsA 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.ResultsOf 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.ConclusionsAlthough 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.

Highlights

Coronavirus disease 2019 (COVID-19) continues to pose a significant threat to public health worldwide
There have been comprehensive presentations of outcomes associated with antiviral treatments for COVID-19 obtained from randomized controlled design, the number of relevant randomized controlled trials were limited in these studies because they were either published early in the pandemic [4] or had search dates that ended during the middle of the pandemic [5] and many new trails have been published in the past year
A total of 2,284 articles were identified from the search terms, of which 31 studies that included 12,440 patients used randomized controlled designs to examine the efficacy of antiviral therapy on COVID-19 [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]

Summary

Introduction

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. Coronavirus disease 2019 (COVID-19) continues to present a significant challenge to healthcare systems worldwide, with approximately 269 million confirmed cases of the disease that have led to 5.3 million deaths as of December 12, 2021 [1]. As a result of the substantial heterogeneity across studies, a consensus on COVID-19 therapies has remained elusive. Antiviral drugs, such as remdesivir, represent promising drug candidates to attenuate viral and disease progression. We conducted a systematic review of RCTs that examined antiviral efficacy for COVID-19 treatment

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