《COVID-19 非住院患者抗病毒药物的临床疗效和安全性：一项随机对照试验的系统评价和网络荟萃分析》。
The Clinical Efficacy and Safety of Anti-Viral Agents for Non-Hospitalized Patients with COVID-19: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
机构信息
Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan 710, Taiwan.
Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 231, Taiwan.
出版信息
Viruses. 2022 Aug 2;14(8):1706. doi: 10.3390/v14081706.
This network meta-analysis compared the clinical efficacy and safety of anti-viral agents for the prevention of disease progression among non-hospitalized patients with COVID-19. PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched from their inception to 28 May 2022. Only randomized controlled trials (RCTs) that investigated the clinical efficacy of anti-viral agents for non-hospitalized patients with COVID-19 were included. Three RCTs involving 4241 patients were included. Overall, anti-viral agents were associated with a significantly lower risk of COVID-19 related hospitalization or death compared with the placebo (OR, 0.23; 95% CI: 0.06-0.96; = 0.04). Compared with the placebo, patients receiving nirmatrelvir plus ritonavir had the lowest risk of hospitalization or death (OR, 0.12; 95% CI: 0.06-0.24), followed by remdesivir (OR, 0.13; 95% CI: 0.03-0.57) and then molnupiravir (OR, 0.67; 95% CI: 0.46-0.99). The rank probability for each treatment calculated using the P-score revealed that nirmatrelvir plus ritonavir was the best anti-viral treatment, followed by remdesivir and then molnupiravir. Finally, anti-viral agents were not associated with an increased risk of adverse events compared with the placebo. For non-hospitalized patients with COVID-19 who are at risk of disease progression, the currently recommended three anti-viral agents, nirmatrelvir plus ritonavir, molnupiravir and remdesivir, should continue to be recommended for the prevention of disease progression. Among them, oral nirmatrelvir plus ritonavir and intravenous remdesivir seem to be the better choice, followed by molnupiravir, as determined by this network meta-analysis. Additionally, these three anti-viral agents were shown to be as tolerable as the placebo in this clinical setting.
这项网络荟萃分析比较了抗病毒药物在预防非住院 COVID-19 患者疾病进展方面的临床疗效和安全性。从建库到 2022 年 5 月 28 日，我们检索了 PubMed、Embase、Web of Science、Cochrane 图书馆、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台。仅纳入了评估抗病毒药物在非住院 COVID-19 患者中的临床疗效的随机对照试验（RCT）。共纳入 3 项 RCT，涉及 4241 例患者。总体而言，与安慰剂相比，抗病毒药物显著降低 COVID-19 相关住院或死亡风险（OR，0.23；95%CI：0.06-0.96； = 0.04）。与安慰剂相比，接受奈玛特韦/利托那韦的患者住院或死亡风险最低（OR，0.12；95%CI：0.06-0.24），其次是瑞德西韦（OR，0.13；95%CI：0.03-0.57），然后是莫努匹韦（OR，0.67；95%CI：0.46-0.99）。使用 P 评分计算的每种治疗方法的秩概率表明，奈玛特韦/利托那韦是最佳的抗病毒治疗方法，其次是瑞德西韦，然后是莫努匹韦。最后，与安慰剂相比，抗病毒药物并未增加不良反应风险。对于有疾病进展风险的非住院 COVID-19 患者，目前推荐的三种抗病毒药物奈玛特韦/利托那韦、莫努匹韦和瑞德西韦，应继续推荐用于预防疾病进展。在该临床环境中，这三种抗病毒药物与安慰剂一样耐受。在该网络荟萃分析中，奈玛特韦/利托那韦口服和瑞德西韦静脉输注似乎是更好的选择，其次是莫努匹韦。
Zotero 插件