• Logo
  • SBMUJournals

Antiviral therapy in management of COVID-19: a systematic review on current evidence

Mahmoud Yousefifard, Alireza Zali, Kosar Mohamed Ali, Arian Madani Neishaboori, Afshin Zarghi, Mostafa Hosseini, Saeed Safari
455

Views


Abstract

Background: The purpose of the current systematic review is to evaluate the efficacy of antiviral therapies in treatment of COVID-19. In addition, clinical trials on the efficacy of antiviral therapies in the management of Severe Acute Respiratory Syndrome coronavirus (SARS-Cov) or Middle East Respiratory Syndrome coronavirus (MERS-CoV) have also been reviewed, in order to identify potential treatment options for COVID-19.

Method: An extensive search was performed in Medline, Embase, Scopus, Web of Science and CENTRAL databases until the end of March 15, 2020. Two independent researchers performed the screening, and finally the related studies were included.

Results: Only one clinical trial on the efficacy of antiviral therapy in management of COVID-19 was found. The results depicted that adding Lopinavir-Ritonavir to the standard treatment regimen of patients with severe COVID-19 has no benefits. Moreover, 21 case-series and case-report studies reported the prescription of antiviral agents in COVID-19, none of which can be used to determine the efficacy of antiviral therapies in confronting COVID-19. In addition, no clinical trials were found to be performed on the efficacy of antiviral agents in the management of SARS-CoV and MERS-CoV.

Conclusion: The current evidence impede researchers from proposing an appropriate antiviral therapy against COVID-19, making the current situation a serious concern for international organizations such as World Health Organization (WHO). In the time of the current pandemic and future epidemics, organizations such as WHO should pursue more proactive actions and plan well-designed clinical trials so that their results can be used in managing future epidemics.


Keywords

COVID-19; Treatment; Antiviral Therapy

References

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama. 2020:[In press].

Alavi-Moghaddam M. A Novel Coronavirus (COVID-19) Outbreak from Wuhan City in China, Rapid Need for Emergency Departments Preparedness and Response; a Letter to Editor. 2020. 2020;8(1):e12.

World Metrics. COVID-19 coronavirus outbreak: World Metrics; [Available from: https://www.worldometers.info/coronavirus/.

Luk HKH, Li X, Fung J, Lau SKP, Woo PCY. Molecular epidemiology, evolution and phylogeny of SARS coronavirus. Infection, Genetics and Evolution. 2019;71:21-30.

Chen X, Chughtai AA, Dyda A, MacIntyre CR. Comparative epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia and South Korea. Emerging microbes & infections. 2017;6(1):1-6.

Alavi-Moghaddam M. A Novel Coronavirus (COVID-19) Outbreak from Wuhan City in China, Rapid Need for Emergency Departments Preparedness and Response; a Letter to Editor. 2020. 2020;8(1).

Rismanbaf A. Potential treatments for COVID-19; a literature review. 2020. 2020;8(1):e29.

Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. The Lancet Respiratory Medicine. 2020.

Zhu R-f, Gao R-l, Robert S-H, Gao J-p, Yang S-g, Zhu C. Systematic Review of the Registered Clinical Trials of Coronavirus Diseases 2019 (COVID-19). medRxiv. 2020:[In press].

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine. 2020:[In press].

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-13.

Chen Q, Quan B, Li X, Gao G, Zheng W, Zhang J, et al. A report of clinical diagnosis and treatment of 9 cases of coronavirus disease 2019. Journal of medical virology. 2020:[In press].

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. The New England journal of medicine. 2020.

Han X, Fan Y, Wan YL, Shi H. A Diabetic Patient With 2019-nCoV Infection Who Recovered and Was Discharged From Hospital. Journal of thoracic imaging. 2020:[In press].

Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Science China Life Sciences. 2020:1-6.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506.

Li W, Cui H, Li K, Fang Y, Li S. Chest computed tomography in children with COVID-19 respiratory infection. Pediatric Radiology. 2020:[In press].

Lim J, Jeon S, Shin HY, Kim MJ, Seong YM, Lee WJ, et al. Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the Treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR. Journal of Korean medical science. 2020;35(6):e79.

Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chinese medical journal. 2020:[In press].

Liu L, Jian-Ya G, Wan-mei H, Xian-xiangJian-ya G. Clinical characteristics of 51 patients discharged from hospital with COVID-19 in Chongqing, China. medRxiv. 2020:[In press].

Qin X, Qiu S, Yuan Y, Zong Y, Tuo Z, Li J, et al. Clinical Characteristics and Treatment of Patients Infected with COVID-19 in Shishou, China. Lancet Respiratory Medicine. 2020:Pre-Print. Available at SSRN: https://ssrn.com/abstract=3541147.

Shang J, Du R, Lu Q, Wu J, Xu S, Ke Z, et al. The Treatment and Outcomes of Patients with COVID-19 in Hubei, China: A Multi-Centered, Retrospective, Observational Study. Lancet. 2020:Pre-Print. Available at SSRN: https://ssrn.com/abstract=3546060.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama. 2020;323(11):1061-9.

Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Bioscience trends. 2020;14(1):64-8.

Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D, et al. Clinical Characteristics of Imported Cases of COVID-19 in Jiangsu Province: A Multicenter Descriptive Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020:[In press].

Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ (Clinical research ed). 2020;368:m606.

Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. The Journal of infection. 2020:[In press].

Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. Jama. 2020:[In press].

Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and outcomes of 221 patients with COVID-19 in Wuhan, China. medRxiv. 2020:Pre-Print. Available at MedRxiv: https://www.medrxiv.org/content/10.1101/2020.03.02.20030452v1.

Zhang Z, Li X, Zhang W, Shi ZL, Zheng Z, Wang T. Clinical Features and Treatment of 2019-nCov Pneumonia Patients in Wuhan: Report of A Couple Cases. Virologica Sinica. 2020:[In press].

Zhou Z, Xie S, Zhang J, Zheng F, Jiang D, Li K, et al. Short-Term Moderate-Dose Corticosteroid Plus Immunoglobulin Effectively Reverses COVID-19 Patients Who Have Failed Low-Dose Therapy. Pre-prints. 2020:Available at: https://www.preprints.org/manuscript/202003.0065/v1.

Arabi YM, Asiri AY, Assiri AM, Jokhdar HAA, Alothman A, Balkhy HH, et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials. 2020;21(1):1-8.

Momattin H, Al-Ali AY, Al-Tawfiq JA. A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel medicine and infectious disease. 2019;30:9-18.

Dawson P, Malik MR, Parvez F, Morse SS. What Have We Learned about Middle East Respiratory Syndrome Coronavirus Emergence in Humans? A Systematic Literature Review. Vector-Borne and Zoonotic Diseases. 2019;19(3):174-92.

Morra ME, Van Thanh L, Kamel MG, Ghazy AA, Altibi AMA, Dat LM, et al. Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta-analysis. Reviews in medical virology. 2018;28(3):e1977.

Gross AE, Bryson ML. Oral Ribavirin for the Treatment of Noninfluenza Respiratory Viral Infections: A Systematic Review. The Annals of pharmacotherapy. 2015;49(10):1125-35.

Momattin H, Mohammed K, Zumla A, Memish ZA, Al-Tawfiq JA. Therapeutic Options for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) - possible lessons from a systematic review of SARS-CoV therapy. International Journal of Infectious Diseases. 2013;17(10):e792-e8.

Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS medicine. 2006;3(9):e343.




DOI: https://doi.org/10.22037/aaem.v8i1.658

DOI (PDF): https://doi.org/10.22037/aaem.v8i1.658.g765

DOI (HTML): https://doi.org/10.22037/aaem.v8i1.658.g797