Charan Thej Reddy Vegivinti1, Kirk W Evanson2, Hannah Lyons3,4, Izzet Akosman3,5, Averi Barrett3, Nicole Hardy3, Bernadette Kane2, Praneeth Reddy Keesari6, Yashwitha Sai Pulakurthi6, Erin Sheffels7, Prasanth Balasubramanian1, Richa Chibbar8, Spandana Chittajallu9, Kathryn Cowie3, J Karon3, Lauren Siegel3, Ranita Tarchand3, Caleb Zinn3, Nitin Gupta10,11, Kevin M Kallmes3, Kavitha Saravu10,11, Jillienne Touchette2. 1. Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY, USA. 2. Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA. 3. Nested Knowledge, 1430 Avon Street N, Saint Paul, MN, 55117, USA. 4. Ohio University Heritage College of Osteopathic Medicine, 6775 Bobcat Way, Dublin, OH, 43016, USA. 5. Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA. 6. Kamineni Academy of Medical Sciences and Research Center, Hyderabad, Telangana, 500068, India. 7. Superior Medical Experts, 1425 Minnehaha Ave E, P.O. Box 6000545, St Paul, MN, 55106, USA. erinsheffels@supedit.com. 8. Department of Medicine, Lakeridge Health, 1 Hospital Crt, Oshawa, ON, L1G 2B9, Canada. 9. Reading Hospital, 420 South 5th Avenue, West Reading, PA, 19611, USA. 10. Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India. 11. Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Abstract
BACKGROUND: 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. METHODS: A 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. RESULTS: Of 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. CONCLUSIONS: Although 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.
BACKGROUND: 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. METHODS: A 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. RESULTS: Of 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. CONCLUSIONS: Although 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.
Authors: Reaz Mahmud; Md Mujibur Rahman; Iftikher Alam; Kazi Gias Uddin Ahmed; A K M Humayon Kabir; S K Jakaria Been Sayeed; Mohammad Aftab Rassel; Farhana Binte Monayem; Md Shahidul Islam; Mohammad Monirul Islam; Anindita Das Barshan; Mohammad Mahfuzul Hoque; Md Uzzal Mallik; Mohammad Abdullah Yusuf; Mohammad Zaid Hossain Journal: J Int Med Res Date: 2021-05 Impact factor: 1.671
Authors: František Duška; Petr Waldauf; Milada Halačová; Václav Zvoníček; Jakub Bala; Martin Balík; Jan Beneš; Olga Klementová; Irena Kozáková; Viktor Kubricht; Anne Le Roy; Tomáš Vymazal; Veronika Řehořová; Vladimír Černý Journal: Trials Date: 2020-07-08 Impact factor: 2.279
Authors: Gilmar Reis; Eduardo Augusto Dos Santos Moreira Silva; Daniela Carla Medeiros Silva; Lehana Thabane; Gurmit Singh; Jay J H Park; Jamie I Forrest; Ofir Harari; Castilho Vitor Quirino Dos Santos; Ana Paula Figueiredo Guimarães de Almeida; Adhemar Dias de Figueiredo Neto; Leonardo Cançado Monteiro Savassi; Aline Cruz Milagres; Mauro Martins Teixeira; Maria Izabel Campos Simplicio; Luciene Barra Ribeiro; Rosemary Oliveira; Edward J Mills Journal: JAMA Netw Open Date: 2021-04-01
Authors: Nikolaos Spanakis; Sotirios Tsiodras; Bart L Haagmans; V Stalin Raj; Kostantinos Pontikis; Antonia Koutsoukou; Nikolaos G Koulouris; Albert D M E Osterhaus; Marion P G Koopmans; Athanassios Tsakris Journal: Int J Antimicrob Agents Date: 2014-09-18 Impact factor: 5.283
Authors: Elizabeth M Goldberg; Lauren T Southerland; Andrew C Meltzer; Justine Pagenhardt; Ryan Hoopes; Carlos A Camargo; Jeffrey A Kline Journal: J Am Geriatr Soc Date: 2022-04-29 Impact factor: 7.538
Authors: Szymon Urban; Michał Fułek; Mikołaj Błaziak; Gracjan Iwanek; Maksym Jura; Katarzyna Fułek; Mateusz Guzik; Mateusz Garus; Piotr Gajewski; Łukasz Lewandowski; Jan Biegus; Piotr Ponikowski; Przemysław Trzeciak; Agnieszka Tycińska; Robert Zymliński Journal: J Clin Med Date: 2022-09-21 Impact factor: 4.964