The Clinical Efficacy and Safety of Anti-Viral Agents for Non-Hospitalized Patients with COVID-19: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

被引：55

作者：

Lai, Chih-Cheng ^{[1
]}

Wang, Ya-Hui ^{[2
,3
]}

Chen, Kuang-Hung ^{[4
]}

Chen, Chao-Hsien ^{[5
,6
]}

Wang, Cheng-Yi ^{[3
,7
]}

机构：

[1] Div Hosp Med, Chi Mei Med Ctr, Dept Internal Med, Tainan 710, Taiwan

[2] Fu Jen Catholic Univ, Cardinal Tien Hosp, Med Res Ctr, New Taipei 231, Taiwan

[3] Fu Jen Catholic Univ, Coll Med, Sch Med, New Taipei 231, Taiwan

[4] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Coll Med, Dept Internal Med, Taipei 100, Taiwan

[5] MacKay Mem Hosp, Dept Internal Med, Div Pulm, Taipei 104, Taiwan

[6] MacKey Med Coll, Dept Med, New Taipei 252, Taiwan

[7] Fu Jen Catholic Univ, Cardinal Tien Hosp, Dept Internal Med, New Taipei 231, Taiwan

来源：

VIRUSES-BASEL | 2022年 / 14卷 / 08期

关键词：

COVID-19; nirmatrelvir plus ritonavir; remdesivir; molnupiravir;

D O I：

10.3390/v14081706

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

This network meta-analysis compared the clinical efficacy and safety of anti-viral agents for the prevention of disease progression among non-hospitalized patients with COVID-19. PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched from their inception to 28 May 2022. Only randomized controlled trials (RCTs) that investigated the clinical efficacy of anti-viral agents for non-hospitalized patients with COVID-19 were included. Three RCTs involving 4241 patients were included. Overall, anti-viral agents were associated with a significantly lower risk of COVID-19 related hospitalization or death compared with the placebo (OR, 0.23; 95% CI: 0.06-0.96; p = 0.04). Compared with the placebo, patients receiving nirmatrelvir plus ritonavir had the lowest risk of hospitalization or death (OR, 0.12; 95% CI: 0.06-0.24), followed by remdesivir (OR, 0.13; 95% CI: 0.03-0.57) and then molnupiravir (OR, 0.67; 95% CI: 0.46-0.99). The rank probability for each treatment calculated using the P-score revealed that nirmatrelvir plus ritonavir was the best anti-viral treatment, followed by remdesivir and then molnupiravir. Finally, anti-viral agents were not associated with an increased risk of adverse events compared with the placebo. For non-hospitalized patients with COVID-19 who are at risk of disease progression, the currently recommended three anti-viral agents, nirmatrelvir plus ritonavir, molnupiravir and remdesivir, should continue to be recommended for the prevention of disease progression. Among them, oral nirmatrelvir plus ritonavir and intravenous remdesivir seem to be the better choice, followed by molnupiravir, as determined by this network meta-analysis. Additionally, these three anti-viral agents were shown to be as tolerable as the placebo in this clinical setting.

引用

页数：10

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