COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Liu W, Zhou P, Chen K, et al. Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis. CMAJ. 2020 Jul 6;192(27):E734-E744. doi: 10.1503/cmaj.200647. Epub 2020 Jun 3.

BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19.

METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes.

RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting.

INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.

Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Public Health
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

The information is important for practitioners to know, and also for patients to be aware of.

General Internal Medicine-Primary Care(US) rater

This is early data on Covid treatment; rush to rigor. This analysis attempts to identify research on antiviral therapies. Very few studies have achieved sufficient rigor, to date. As we have heard, there have been no ‘silver bullets’ to date. It will take time to build enough rigorous data and analyses to provide real guidance.

Intensivist/Critical Care rater

This is a well done reference source that demonstrates that no antiviral has any effect on COVID.

Internal Medicine rater

This is not really new information. There is still no evidence for any treatment against Covid-19.

Public Health rater

This is a very important review. The use of a systematic methodology and a very comprehensive searching process was the strength of this review. This six-months pandemic has taught us many things. This review showed that none of promising anti-virals were proven effective for COVID-19. The treatment strategy is still supportive and enhances the immune system. Further reviews and trials are warranted.