Effect of sofosbuvir-based treatment on clinical outcomes of patients with COVID-19: a systematic review and meta-analysis of randomised controlled trials

This systematic review and meta-analysis examined the efficacy of sofosbuvir-based antiviral treatment against COVID-19 (coronavirus disease 2019). PubMed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched from inception to 15 August 2021. Studies comparing the clin-ical efficacy and safety of sofosbuvir-based antiviral regimens (study group) with other antivirals or stan-dard of care (control group) in patients with COVID-19 were included. Overall, 687 patients with COVID-19 were included, of which 377 patients received sofosbuvir-based treatment. Mortality was lower in the study group than in the control group [odds ratio (OR) = 0.49, 95% confidence interval (CI) 0.30- 0.79; I 2 = 0%]. The overall clinical recovery rate was higher in the study group than in the control group (OR = 1.82, 95% CI 1.20-2.76; I 2 = 28%). The study group presented a lower requirement for mechanical ventilation (OR = 0.33, 95% CI 0.13-0.89; I 2 = 0%) and intensive care unit admission (OR = 0.42, 95% CI 0.25-0.70; I 2 = 0%) than the control group. Furthermore, the study group exhibited a shorter hos-pital length of stay [mean deviation (MD), -1.49, 95% CI -2.62 to -0.37; I 2 = 56%] and recovery time (MD, -1.34, 95% CI -2.29 to -0.38; I 2 = 46%) than the control group. Sofosbuvir-based treatment may help reduce mortality in patients with COVID-19 and improve associated clinical outcomes. Furthermore, sofosbuvir-based treatment was as safe as the comparator in patients with COVID-19. However, further large-scale studies are warranted to validate these findings.(c) 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.