• Qianling Shi, Qi Zhou, Xia Wang, Jing Liao, Yang Yu, Zijun Wang, Shuya Lu, Yanfang Ma, Yangqin Xun, Xufei Luo, Weiguo Li, Toshio Fukuoka, AhnHyeong SikHSDepartment of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.Korea Cochrane Centre, Seoul, Korea., Myeong Soo Lee, Zhengxiu Luo, Enmei Liu, Yaolong Chen, Qubei Li, Kehu Yang, Quanlin Guan, and COVID-19 Evidence and Recommendations Working Group.
• The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
• Ann Transl Med. 2020 May 1; 8 (10): 624.

BackgroundThe COVID-19 outbreak presents a new, life-threatening disease. Our aim was to assess the potential effectiveness and safety of antiviral agents for COVID-19 in children.MethodsElectronic databases (MEDLINE, Embase, Web of Science, the Cochrane library, CBM, CNKI, and Wanfang Data) from their inception to March 31, 2020 were searched for randomized controlled trials (RCTs), clinical controlled trials and cohort studies of interventions with antiviral agents for children (less than 18 years of age) with COVID-19.ResultsA total of 23 studies with 6,008 patients were included. There was no direct evidence and all of evidence were indirect. The risks of bias in all studies were moderate to high in general. The effectiveness and safety of antiviral agents for children with COVID-19 is uncertain: For adults with COVID-19, lopinavir/ritonavir had no effect on mortality [risk ratio (RR) =0.77; 95% confidence interval (CI), 0.45 to 1.30]. Arbidol and hydroxychloroquine (HCQ) had no benefit on probability of negative PCR test (RR =1.27; 95% CI, 0.93 to 1.73; RR =0.93; 95% CI, 0.73 to 1.18) respectively. For adults with SARS, interferon was associated with reduced corticosteroid dose [weighted mean difference (WMD) = -0.14 g; 95% CI, -0.21 to -0.07] but had no effect on mortality (RR =0.72; 95% CI, 0.28 to 1.88); ribavirin did not reduce mortality (RR =0.68; 95% CI, 0.43 to 1.06) and was associated with high risk of severe adverse reactions; and oseltamivir had no effect on mortality (RR =0.87; 95% CI, 0.55 to 1.38). Ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions.ConclusionsThere is no evidence showing the effectiveness of antiviral agents for children with COVID-19, and the clinical efficacy of existing antiviral agents is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 in children, with the exception of clinical trials.2020 Annals of Translational Medicine. All rights reserved.

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