The effect of antivirals on COVID-19: a systematic review

ABSTRACT

Introduction

Coronavirus Disease 2019 is a contagious infection that has infected millions worldwide. The objective of this systematic review is to identify studies pertaining to antivirals, both as sole and combined therapies, in COVID-19 patients and review the clinical outcomes of these treatment methods.

Areas covered

A systematic review was conducted using Preferred Reporting Items or Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was done on Medline, Global Health, and EMBASE using keywords and MeSH terms relevant to COVID- 19 and antivirals. Limits were put on date to obtain articles between December 2019 to May 2020 (the time at which the search was performed). 776 articles were identified and screened. After screening, 16 studies were included. The narrative synthesis revealed three key themes (1) Use of antivirals only (such as lopinavir, umifenovir, and remdesivir), (2) Use of lopinavir-ritonavir alongside other treatments, and (3) Use of other antivirals in combination with other treatments.

Expert opinion

Using antivirals in combination with other treatments has potential; however, further randomized controlled trials with larger sample sizes are required to identify the best candidate components that should comprise combined treatments for COVID-19. This should optimize treatment efficacy and improve patient outcomes.

KEYWORDS:

• COVID-19
• coronavirus
• antiviral
• treatment

Article highlights

• Antivirals such as lopinavir and remdesivir have been used as both sole therapy and in conjunction with other agents as potential treatment options in COVID-19 patients.

• Learning from previous epidemics has highlighted the potential of antivirals as a therapeutic agent for pathogens genomically similar to SARs-CoV-2

• Antiviral monotherapy did not produce better clinical outcomes.

• Antivirals used within combined treatments show greater promise in improving patient outcomes.

• More randomised controlled trials are required to identify what candidate drugs should be included conjunctively for combined treatments in order to optimize patient outcomes.

Acknowledgments

Nafisa Hussain, Anusha Yoganathan and Savini Hewage contributed equally.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.