Evidence map›Paper›PMID 35878897›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2022

Antiviral drug treatment for nonsevere COVID-19: a systematic review and network meta-analysis.

Tyler Pitre, Rebecca Van Alstine, Genevieve Chick, Gareth Leung, David Mikhail, Ellen Cusano, Faran Khalid, Dena Zeraatkar

Open access · goldAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 7 pooled it
6.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 7 syntheses or guidelines pooled it, 63 citations in OpenAlex.

  1. Pooled it
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  4. Molnupiravir for treatment of adults with mild or moderate COVID-19: a systematic review and meta-analysis of randomized controlled trials.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023
    Pooled it
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  8. Trial
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  11. Observational
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  13. Observational
  14. Review
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  17. AMMI Canada Practice Point: Updated recommendations for treatment of adults with symptomatic COVID-19 in 2023-2024.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 1 institution in 2 countries.

Tyler PitreDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Rebecca Van AlstineDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Genevieve ChickDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Gareth LeungDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
David MikhailDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Ellen CusanoDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Faran KhalidDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont.
Dena ZeraatkarDivision of Internal Medicine (Pitre), McMaster University, Hamilton, Ont.; Department of Medicine (Pitre, Van Alstine, Chick), Grand River Hospital, Kitchener, Ont.; Michael G. DeGroote School of Medicine (Pitre, Van Alstine, Chick, Khalid), McMaster University, Hamilton, Ont.; Faculty of Medicine (Leung), University of Ottawa, Ottawa, Ont.; Faculty of Health Sciences (Mikhail), McMaster University, Hamilton, Ont.; Division of Hematology and Hematological Malignancies (Cusano), Department of Medicine, University of Calgary, Alta.; Harvard Medical School (Zeraatkar), Harvard University, Boston, Mass.; Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Zeraatkar), McMaster University, Hamilton, Ont. Dena_Zeraatkar@hms.harvard.edu.
Harvard University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRandomized trial evidence suggests that some antiviral drugs are effective in patients with COVID-19. However, the comparative effectiveness of antiviral drugs in nonsevere COVID-19 is unclear.

methodsWe searched the Epistemonikos COVID-19 L·OVE (Living Overview of Evidence) database for randomized trials comparing antiviral treatments, standard care or placebo in adult patients with nonsevere COVID-19 up to Apr. 25, 2022. Reviewers extracted data and assessed risk of bias. We performed a frequentist network meta-analysis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

resultsWe identified 41 trials, which included 18 568 patients. Compared with standard care or placebo, molnupiravir and nirmatrelvir-ritonavir each reduced risk of death with moderate certainty (10.9 fewer deaths per 1000, 95% confidence interval [CI] 12.6 to 4.5 fewer for molnupiravir; 11.7 fewer deaths per 1000, 95% CI 13.1 fewer to 2.6 more). Compared with molnupiravir, nirmatrelvir-ritonavir probably reduced risk of hospital admission (27.8 fewer admissions per 1000, 95% CI 32.8 to 18.3 fewer; moderate certainty). Remdesivir probably has no effect on risk of death, but may reduce hospital admissions (39.1 fewer admissions per 1000, 95% CI 48.7 to 13.7 fewer; low certainty).

interpretationMolnupiravir and nirmatrelvir-ritonavir probably reduce risk of hospital admissions and death among patients with nonsevere COVID-19. Nirmatrelvir-ritonavir is probably more effective than molnupiravir for reducing risk of hospital admissions. Most trials were conducted with unvaccinated patients, before the emergence of the Omicron variant; the effectiveness of these drugs must thus be tested among vaccinated patients and against newer variants.

Indexed as

COVID-19 Drug TreatmentAdultAntiviral AgentsHumansRitonavirSARS-CoV-2Antiviral AgentsRitonavir

Identifiers

PMID35878897
PMCPMC9328465
OpenAlexW4287092671

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.