• Tyler Pitre, Rebecca Van Alstine, Genevieve Chick, Gareth Leung, David Mikhail, Ellen Cusano, Faran Khalid, and Dena Zeraatkar.
• Division of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
• CMAJ. 2022 Jul 25; 194 (28): E969E980E969-E980.

BackgroundRandomized trial evidence suggests that some antiviral drugs are effective in patients with COVID-19. However, the comparative effectiveness of antiviral drugs in nonsevere COVID-19 is unclear.MethodsWe searched the Epistemonikos COVID-19 L·OVE (Living Overview of Evidence) database for randomized trials comparing antiviral treatments, standard care or placebo in adult patients with nonsevere COVID-19 up to Apr. 25, 2022. Reviewers extracted data and assessed risk of bias. We performed a frequentist network meta-analysis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsWe identified 41 trials, which included 18 568 patients. Compared with standard care or placebo, molnupiravir and nirmatrelvir-ritonavir each reduced risk of death with moderate certainty (10.9 fewer deaths per 1000, 95% confidence interval [CI] 12.6 to 4.5 fewer for molnupiravir; 11.7 fewer deaths per 1000, 95% CI 13.1 fewer to 2.6 more). Compared with molnupiravir, nirmatrelvir-ritonavir probably reduced risk of hospital admission (27.8 fewer admissions per 1000, 95% CI 32.8 to 18.3 fewer; moderate certainty). Remdesivir probably has no effect on risk of death, but may reduce hospital admissions (39.1 fewer admissions per 1000, 95% CI 48.7 to 13.7 fewer; low certainty).InterpretationMolnupiravir and nirmatrelvir-ritonavir probably reduce risk of hospital admissions and death among patients with nonsevere COVID-19. Nirmatrelvir-ritonavir is probably more effective than molnupiravir for reducing risk of hospital admissions. Most trials were conducted with unvaccinated patients, before the emergence of the Omicron variant; the effectiveness of these drugs must thus be tested among vaccinated patients and against newer variants.© 2022 CMA Impact Inc. or its licensors.

11 keywords...

hide…