Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Krems, Austria (I.S., D.L., K.T., A.D., E.P., M.F., I.K.).
Cochrane Austria, Department for Evidence-based Medicine and Evaluation, University for Continuing Education Krems (Danube University Krems), Krems, Austria; and RTI International, Research Triangle Park, North Carolina (G.G.).
Ann Intern Med. 2023 Oct;176(10):1377-1385. doi: 10.7326/M23-1626. Epub 2023 Sep 19.
Clinicians and patients want to know the benefits and harms of outpatient treatment options for the Omicron variant of SARS-CoV-2.
To assess the benefits and harms of 22 different COVID-19 treatments.
The Epistemonikos COVID-19 L·OVE platform, the iSearch COVID-19 portfolio, and the World Health Organization (WHO) COVID-19 Research Database from 26 November 2021 to 2 March 2023.
Two reviewers independently screened abstracts and full texts against a priori-defined criteria.
One reviewer extracted the data and assessed the risk of bias and certainty of evidence (COE). A second reviewer verified the data abstraction and assessments.
Two randomized controlled trials and 6 retrospective cohort studies were included. Nirmatrelvir-ritonavir was associated with a reduction in hospitalization due to COVID-19 (for example, 0.7% vs. 1.2%; moderate COE) and all-cause mortality (for example, <0.1% vs. 0.2%; moderate COE). Molnupiravir led to a higher recovery rate (31.8% vs. 22.6%; moderate COE) and reduced time to recovery (9 vs. 15 median days; moderate COE) but had no effect on all-cause mortality (0.02% vs. 0.04%; moderate COE) and the incidence of serious adverse events (0.4% vs. 0.3%; moderate COE). Ivermectin had no effect on time to recovery (moderate COE) and resulted in no difference in adverse events compared with placebo (low COE). Sotrovimab resulted in no difference in all-cause mortality compared with no treatment (low COE). No eligible studies for all other treatments of interest were identified.
Evidence for nirmatrelvir-ritonavir and sotrovimab is based on nonrandomized studies only.
Nirmatrelvir-ritonavir and molnupiravir probably improve outcomes for outpatients with mild to moderate COVID-19.
American College of Physicians. (PROSPERO: CRD42023406456).
临床医生和患者希望了解针对 SARS-CoV-2 奥密克戎变异株的门诊治疗方案的获益和危害。
评估 22 种不同 COVID-19 治疗方法的获益和危害。
2021 年 11 月 26 日至 2023 年 3 月 2 日，Epistemonikos COVID-19 L·OVE 平台、iSearch COVID-19 组合以及世界卫生组织（WHO）COVID-19 研究数据库。
两名审查员根据预先确定的标准独立筛选摘要和全文。
一名审查员提取数据并评估偏倚风险和证据确定性（COE）。第二名审查员验证数据提取和评估。
纳入两项随机对照试验和 6 项回顾性队列研究。奈玛特韦-利托那韦与因 COVID-19 住院的减少相关（例如，0.7%比 1.2%；COE 为中等）和全因死亡率（例如，<0.1%比 0.2%；COE 为中等）。莫努匹韦导致更高的康复率（31.8%比 22.6%；COE 为中等）和恢复时间缩短（9 比 15 天中位数；COE 为中等），但对全因死亡率（0.02%比 0.04%；COE 为中等）和严重不良事件发生率（0.4%比 0.3%；COE 为中等）没有影响。伊维菌素对恢复时间没有影响（COE 为中等），与安慰剂相比，不良事件没有差异（COE 为低）。索托维单抗与不治疗相比，全因死亡率没有差异（COE 为低）。没有发现其他感兴趣的治疗方法的合格研究。
奈玛特韦-利托那韦和索托维单抗的证据仅基于非随机研究。
奈玛特韦-利托那韦和莫努匹韦可能改善门诊轻度至中度 COVID-19 患者的结局。
美国医师学院。（PROSPERO：CRD42023406456）。
