早期使用口服抗病毒药物与新冠后综合征风险：一项系统评价和网状Meta分析

Early use of oral antiviral drugs and the risk of post COVID-19 syndrome: A systematic review and network meta-analysis.

作者信息

Jiang Juan, Li Yantong, Jiang Qiaoling, Jiang Yu, Qin Hongqian, Li Yuanyuan

机构信息

Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China; Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China; Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.

出版信息

J Infect. 2024 Aug;89(2):106190. doi: 10.1016/j.jinf.2024.106190. Epub 2024 Jun 2.

DOI:10.1016/j.jinf.2024.106190

PMID:38834107

Abstract

OBJECTIVES

This study aimed to determine the association of early use of oral antiviral drugs (including nirmatrelvir-ritonavir and molnupiravir) with the risk of post COVID-19 condition (PCC) and compare the possible efficacy of nirmatrelvir-ritonavir and molnupiravir.

METHODS

PubMed, Web of Science, Embase, Cochrane, MedRxiv, and Psycinfo were searched from inception until November 1, 2023. We included studies that assessed the effect of oral antiviral drugs on the incidence of PCC. Pairwise and network meta-analyses were conducted using a random-effects model. Risk ratios (RRs) for oral antiviral drugs were calculated with a confidence interval (CI).

RESULTS

Nine observational studies containing 866,066 patients were included. Nirmatrelvir-ritonavir and molnupiravir were evaluated in eight and two studies respectively, with both drugs evaluated in one study. Pair-wise meta-analysis showed that early oral antiviral drugs reduced PCC risk (RR 0.77, 95% CI 0.68-0.88). Network meta-analysis showed that nirmatrelvir-ritonavir may perform better than molnupiravir (surface under the cumulative ranking curve: 95.5% vs. 31.6%) at reducing PCC risk.

CONCLUSIONS

Early use of oral antiviral drugs may potentially protect against developing PCC in non-hospitalized patients with COVID-19. These findings support the standardized administration of oral antiviral drugs in patients during the acute phase of COVID-19 according to the guidelines.

摘要

目的

本研究旨在确定早期使用口服抗病毒药物（包括奈玛特韦-利托那韦和莫努匹韦）与新冠后状况（PCC）风险之间的关联，并比较奈玛特韦-利托那韦和莫努匹韦的可能疗效。

方法

检索了从创刊至2023年11月1日的PubMed、科学网、Embase、Cochrane、MedRxiv和Psycinfo。我们纳入了评估口服抗病毒药物对PCC发病率影响的研究。采用随机效应模型进行成对和网络荟萃分析。计算口服抗病毒药物的风险比（RRs）及其置信区间（CI）。

结果

纳入了9项观察性研究，共866,066例患者。分别在8项和2项研究中评估了奈玛特韦-利托那韦和莫努匹韦，两项药物在1项研究中均有评估。成对荟萃分析表明，早期口服抗病毒药物可降低PCC风险（RR 0.77，95%CI 0.68-0.88）。网络荟萃分析表明，在降低PCC风险方面，奈玛特韦-利托那韦可能比莫努匹韦表现更好（累积排名曲线下面积：95.5%对31.6%）。