PT  - JOURNAL ARTICLE
AU  - Wei Liu
AU  - Pengxiang Zhou
AU  - Ken Chen
AU  - Zhikang Ye
AU  - Fang Liu
AU  - Xiaotong Li
AU  - Na He
AU  - Ziyang Wu
AU  - Qi Zhang
AU  - Xuepeng Gong
AU  - Qiyu Tang
AU  - Xin Du
AU  - Yingqiu Ying
AU  - Xiaohan Xu
AU  - Yahui Zhang
AU  - Jinyu Liu
AU  - Yun Li
AU  - Ning Shen
AU  - Rachel J. Couban
AU  - Quazi I. Ibrahim
AU  - Gordon Guyatt
AU  - Suodi Zhai
TI  - Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis
AID  - 10.1503/cmaj.200647
DP  - 2020 Jul 06
TA  - Canadian Medical Association Journal
PG  - E734--E744
VI  - 192
IP  - 27
4099  - http://www.cmaj.ca/content/192/27/E734.short
4100  - http://www.cmaj.ca/content/192/27/E734.full
SO  - CMAJ2020 Jul 06; 192
AB  - BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19.METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes.RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting.INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.200648