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REVIEW ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 4  |  Page : 222-231

Efficacy and safety of antivirals for Covid-19: A systematic review and meta-analysis


1 Department of Community Medicine, North Delhi Municipal Medical College, New Delhi, India
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pulmonary Medicine, Critical Care and Sleep, All India Institute of Medical Sciences, New Delhi, India
4 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
5 Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
6 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
7 Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Shalimar
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-258X.296203

Background. Coronavirus disease 2019 (Covid-19) has led to a severe medical, social and economic crisis globally. Use of antivirals has given inconsistent results; thus systematic summaries of available evidence are required for any recommendations for treatment. We conducted a systematic review and meta-analysis on the use of antivirals for Covid-19. Methods. The databases we searched were—Medline, Embase, Cochrane CENTRAL and Medrxiv. Title/abstract screening, full-text screening and data abstraction were carried out in duplicate by two researchers. Pooled effect sizes and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method of random effects for meta-analysis. Results. Twenty studies were found eligible for inclusion: 6 randomized controlled trials, 9 cohort studies and 5 case series. Moderate-quality evidence suggests a likely clinical benefit from the use of remdesivir in improving the number of recoveries (RR 1.18; 95% CI 1.07–1.31; I2 = 0%) and time to recovery in days (median –3.02; 95% CI –4.98 to –1.07; I2 = 97%). A possibility of lower mortality is suggested by low-quality evidence with remdesivir (RR 0.74; 95% CI 0.40–1.37, I2 = 58%). Moderate-quality evidence suggests no certain benefit of using lopinavir/ritonavir for Covid-19 compared to arbidol, lopinavir/ritonavir combined with arbidol or other medications used as controls. Conclusion. Further evidence from randomized controlled trials is required for all antivirals to treat Covid-19. At present, remdesivir seems more promising than other antivirals.


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