The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID: a systematic review and meta-analysis

Abstract

BackgroundWhether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear. ObjectivesTo assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms. MethodsA systematic review and meta-analysis. Data sourcesSearches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase. Study eligibility criteriaArticles that reported long COVID incidence post–acute COVID with a follow-up of at least 30 days with no language restrictions. ParticipantsPatients with a COVID-19 diagnosis history. InterventionsPatients treated with antivirals, corticosteroids or mAbs. Assessment of risk of biasQuality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool. Methods of data synthesisBasic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the correlation between treatments and long COVID. ResultsOur search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID-19 antiviral treatment concluded its protective efficacy against long COVID (OR, 0.61; 95% CI, 0.48–0.79; p 0.0002); however, corticosteroid (OR, 1.57; 95% CI, 0.80–3.09; p 0.1913), and mAbs treatments (OR, 0.94; 95% CI, 0.56–1.56; p 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms. ConclusionsOur meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids' potential harmful effects on the post–acute phase of COVID-19.