Evidence map›Paper›PMID 39722466›Full record

SynthesisInfluenza and other respiratory viruses2024

Comparative Effectiveness of Antivirals and Monoclonal Antibodies for Treating COVID-19 Patients Infected With Omicron Variant: A Systematic Review and Network Meta-Analysis.

Kristy T K Lau, Xi Xiong, Carlos K H Wong, Ivan C H Au, Angel Y C Lui, Gavin Y T Tsai, Tingting Wu, Lanlan Li, Eric H Y Lau, Benjamin J Cowling and 1 more

Abstract readSystematic ReviewComparative StudyNetwork Meta-Analysis
In one paragraph

Synthesis in Influenza and other respiratory viruses, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Kristy T K LauDepartment of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.ORCID 0000-0003-4412-2969
Xi XiongDepartment of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.ORCID 0000-0002-9418-7448
Carlos K H WongDepartment of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.ORCID 0000-0002-6895-6071
Ivan C H AuSchool of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.ORCID 0000-0001-5904-8322
Angel Y C LuiDepartment of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Gavin Y T TsaiDepartment of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Tingting WuLaboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, new Territories, Hong Kong SAR, China.ORCID 0000-0003-3609-5016
Lanlan LiDepartment of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.ORCID 0009-0002-5529-5830
Eric H Y LauWHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.ORCID 0000-0002-6688-9637
Benjamin J CowlingLaboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, new Territories, Hong Kong SAR, China.ORCID 0000-0002-6297-7154
Gabriel M LeungLaboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, new Territories, Hong Kong SAR, China.ORCID 0000-0002-2503-6283

Funding

AIR@InnoHKHong Kong Jockey Club Global Health Institute (HKJCGHI)
6 · The paper itself

Abstract

Antiviral drugs likely remain effective against the SARS-CoV-2 Omicron variant, while monoclonal antibody (mAb) therapies have experienced drops in neutralizing ability. This systematic review and network meta-analysis aims to estimate the comparative effectiveness of antivirals and mAb therapies for treating COVID-19 patients infected with Omicron, capturing primarily acute outcomes. We searched multiple databases from July 4 to July 19, 2022, with updates through November 4, 2022. Studies comparing the effectiveness of antivirals or mAb to either nonuser controls or other treatments were included. Risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Data extraction and verification involved five independent researchers. Among 39 studies (727,893 individuals with COVID-19, including 38 nonrandomized trials), nirmatrelvir/ritonavir and sotrovimab were associated with lower risks of mortality (HR = 0.317, 95% credible intervals [CrI] = 0.144-0.678; HR = 0.176, 95%CrI = 0.052-0.527) and hospitalization (HR = 0.479, 95%CrI = 0.319-0.711; HR = 0.489, 95%CrI = 0.293-0.797) compared with nonuser controls. Remdesivir users were associated with a lower risk of hospitalization (HR = 0.367, 95%CrI = 0.147-0.868) but not mortality. Molnupiravir and bebtelovimab showed no significant benefits for these outcomes. In conclusion, among individuals infected with COVID-19 during the Omicron wave, mortality risk was lower with nirmatrelvir/ritonavir or sotrovimab use, whereas hospitalization was reduced with nirmatrelvir/ritonavir, remdesivir, or sotrovimab. Sotrovimab and nirmatrelvir/ritonavir were effective against Omicron B.1.1.529/BA.1 and BA.2/BA.4/BA.5 subvariants, respectively. A key limitation is that findings rely on data from the last search and may be impacted by potential changes in mortality risk due to immune evasion by emerging variants, highlighting the need for ongoing randomized trials across variants and populations.

trial registrationThe study was registered on PROSPERO, CRD42022351508.

Indexed as

Antibodies, MonoclonalAntiviral AgentsCOVID-19 Drug TreatmentSARS-CoV-2Adenosine MonophosphateAlanineAntibodies, Monoclonal, HumanizedAntibodies, NeutralizingCOVID-19HumansRitonavirTreatment OutcomeAdenosine MonophosphateAlanineAntibodies, MonoclonalAntibodies, Monoclonal, HumanizedAntibodies, NeutralizingAntiviral AgentsremdesivirRitonavirsotrovimabantiviralCOVID‐19monoclonal antibodyOmicronSARS‐CoV‐2treatment

Identifiers

PMID39722466
PMCPMC11669747

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.