Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Sci-Tech Inno Center for Infection & Immunity, Shanghai, China.
Clin Microbiol Infect. 2024 Dec;30(12):1505-1513. doi: 10.1016/j.cmi.2024.07.006. Epub 2024 Jul 14.
Whether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear.
To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.
A systematic review and meta-analysis.
Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.
Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions.
Patients with a COVID-19 diagnosis history.
Patients treated with antivirals, corticosteroids or mAbs.
Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.
Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the correlation between treatments and long COVID.
Our search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID-19 antiviral treatment concluded its protective efficacy against long COVID (OR, 0.61; 95% CI, 0.48-0.79; p 0.0002); however, corticosteroid (OR, 1.57; 95% CI, 0.80-3.09; p 0.1913), and mAbs treatments (OR, 0.94; 95% CI, 0.56-1.56; p 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.
Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids' potential harmful effects on the post-acute phase of COVID-19.
急性 COVID-19 治疗是否能预防长新冠发病尚不清楚。
评估抗病毒药物、皮质类固醇和单克隆抗体（mAb）治疗急性 COVID-19 与长新冠发病的关系，并评估其在不同人群和个体症状中的效果。
系统评价和荟萃分析。
截至 2024 年 1 月 29 日，在 PubMed、Medline、Web of Science 和 Embase 中进行了检索。
报告了急性 COVID-19 后长新冠发病的文章，随访时间至少 30 天，无语言限制。
有 COVID-19 诊断史的患者。
接受抗病毒药物、皮质类固醇或 mAb 治疗的患者。
质量评估基于纽卡斯尔-渥太华量表、非随机干预研究的偏倚风险Ⅰ和 Cochrane 偏倚风险工具。
记录了每项研究的基本特征。随机森林模型和荟萃回归用于评估治疗与长新冠的相关性。
我们的检索共确定了 2363 条记录，其中 32 项纳入定性综合分析，25 项纳入荟萃分析。14 项研究急性 COVID-19 抗病毒治疗的结果表明，其对长新冠有保护作用（OR，0.61；95%CI，0.48-0.79；p<0.0002）；然而，皮质类固醇（OR，1.57；95%CI，0.80-3.09；p=0.1913）和 mAb 治疗（OR，0.94；95%CI，0.56-1.56；p=0.8012）并未产生这种效果。进一步的亚组分析表明，抗病毒药物在老年、男性、未接种疫苗和非糖尿病人群中提供了更强的保护。此外，抗病毒药物有效减轻了分析的 22 种长新冠症状中的 8 种。
我们的荟萃分析确定抗病毒药物降低了长新冠的发病风险，因此应推荐用于急性 COVID-19 治疗。mAb 治疗与长新冠之间没有关系，但需要开展研究以明确急性 COVID-19 皮质类固醇对 COVID-19 后急性期的潜在有害影响。
