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Clinical efficacy of antiviral agents against coronavirus disease 2019: A systematic review of randomized controlled trials.
J Microbiol Immunol Infect. 2021 Oct; 54(5):767-775.JM

Abstract

Despite aggressive efforts on containment measures for the coronavirus disease 2019 (COVID-19) pandemic around the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously spreading. Therefore, there is an urgent need for an effective antiviral agent. To date, considerable research has been conducted to develop different approaches to COVID-19 therapy. In addition to early observational studies, which could be limited by study design, small sample size, non-randomized design, or different timings of treatment, an increasing number of randomized controlled trials (RCTs) investigating the clinical efficacy and safety of antiviral agents are being carried out. This study reviews the updated findings of RCTs regarding the clinical efficacy of eight antiviral agents against COVID-19, including remdesivir, lopinavir/ritonavir, favipiravir, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, baloxavir, umifenovir, darunavir/cobicistat, and their combinations. Treatment with remdesivir could accelerate clinical improvement; however, it lacked additional survival benefits. Moreover, 5-day regimen of remdesivir might show adequate effectiveness in patients with mild to moderate COVID-19. Favipiravir was only marginally effective regarding clinical improvement and virological assessment based on the results of small RCTs. The present evidence suggests that sofosbuvir/daclatasvir may improve survival and clinical outcomes in patients with COVID-19. However, the sample sizes for analysis were relatively small, and all studies were exclusively conducted in Iran. Further larger RCTs in other countries are warranted to support these findings. In contrast, the present findings of limited RCTs did not indicate the use of lopinavir/ritonavir, sofosbuvir/ledipasvir, baloxavir, umifenovir, and darunavir/cobicistat in the treatment of patients hospitalized for COVID-19.

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Authors+Show Affiliations

Lai CC
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
Chao CM
Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Hsueh PR
Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.

MeSH

Adenosine MonophosphateAlanineAmidesAntiviral AgentsCarbamatesCobicistatDarunavirDibenzothiepinsDrug CombinationsDrug Therapy, CombinationHumansImidazolesIndolesIranLopinavirMorpholinesPyrazinesPyridonesPyrrolidinesRandomized Controlled Trials as TopicRitonavirSARS-CoV-2SofosbuvirTreatment OutcomeTriazinesValineCOVID-19 Drug Treatment

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34253490

Citation

Lai, Chih-Cheng, et al. "Clinical Efficacy of Antiviral Agents Against Coronavirus Disease 2019: a Systematic Review of Randomized Controlled Trials." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 54, no. 5, 2021, pp. 767-775.
Lai CC, Chao CM, Hsueh PR. Clinical efficacy of antiviral agents against coronavirus disease 2019: A systematic review of randomized controlled trials. J Microbiol Immunol Infect. 2021;54(5):767-775.
Lai, C. C., Chao, C. M., & Hsueh, P. R. (2021). Clinical efficacy of antiviral agents against coronavirus disease 2019: A systematic review of randomized controlled trials. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 54(5), 767-775. https://doi.org/10.1016/j.jmii.2021.05.011
Lai CC, Chao CM, Hsueh PR. Clinical Efficacy of Antiviral Agents Against Coronavirus Disease 2019: a Systematic Review of Randomized Controlled Trials. J Microbiol Immunol Infect. 2021;54(5):767-775. PubMed PMID: 34253490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical efficacy of antiviral agents against coronavirus disease 2019: A systematic review of randomized controlled trials. AU - Lai,Chih-Cheng, AU - Chao,Chien-Ming, AU - Hsueh,Po-Ren, Y1 - 2021/06/26/ PY - 2021/04/12/received PY - 2021/05/18/accepted PY - 2021/7/14/pubmed PY - 2021/11/3/medline PY - 2021/7/13/entrez KW - Antiviral agents KW - COVID-19 KW - Efficacy KW - SARS-CoV-2 SP - 767 EP - 775 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 54 IS - 5 N2 - Despite aggressive efforts on containment measures for the coronavirus disease 2019 (COVID-19) pandemic around the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously spreading. Therefore, there is an urgent need for an effective antiviral agent. To date, considerable research has been conducted to develop different approaches to COVID-19 therapy. In addition to early observational studies, which could be limited by study design, small sample size, non-randomized design, or different timings of treatment, an increasing number of randomized controlled trials (RCTs) investigating the clinical efficacy and safety of antiviral agents are being carried out. This study reviews the updated findings of RCTs regarding the clinical efficacy of eight antiviral agents against COVID-19, including remdesivir, lopinavir/ritonavir, favipiravir, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, baloxavir, umifenovir, darunavir/cobicistat, and their combinations. Treatment with remdesivir could accelerate clinical improvement; however, it lacked additional survival benefits. Moreover, 5-day regimen of remdesivir might show adequate effectiveness in patients with mild to moderate COVID-19. Favipiravir was only marginally effective regarding clinical improvement and virological assessment based on the results of small RCTs. The present evidence suggests that sofosbuvir/daclatasvir may improve survival and clinical outcomes in patients with COVID-19. However, the sample sizes for analysis were relatively small, and all studies were exclusively conducted in Iran. Further larger RCTs in other countries are warranted to support these findings. In contrast, the present findings of limited RCTs did not indicate the use of lopinavir/ritonavir, sofosbuvir/ledipasvir, baloxavir, umifenovir, and darunavir/cobicistat in the treatment of patients hospitalized for COVID-19. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/34253490/Clinical_efficacy_of_antiviral_agents_against_coronavirus_disease_2019:_A_systematic_review_of_randomized_controlled_trials_ DB - PRIME DP - Unbound Medicine ER -