SynthesisVirology journal2025
Efficacy and safety of 3CL protease inhibitors in patients with mild or moderate COVID-19: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Virology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundRemdesivir has been established as a safe treatment for patients with COVID-19. However, given the SARS-CoV-2 random mutations, 3CL protease inhibitors have been studied in recent randomized controlled trials. Therefore, this meta-analysis aims to compare 3CL protease inhibitors versus placebo in patients with mild to moderate COVID-19.
methodsWe systematically searched PubMed, Embase, and Cochrane Central for RCTs comparing the treatment regimens in patients with mild to moderate COVID-19. Outcomes of interest were the number of patients with symptomatic resolution, recovery rates, viral load change from baseline, alleviation rates, any adverse events, and serious/severe adverse events. Risk ratios (RRs) and hazard ratios (HRs) with 95% CI were calculated for binary outcomes, and standardized mean differences (SMDs) were calculated for continuous outcomes. R version 4.3.2 was used for statistical analysis with the random effects model.
resultsTen studies were included, comprising 8,511 patients, of whom 4,654 (55.97%) received 3CL protease inhibitors. Follow-up ranged from 21 to 29 months. In our time-to-event analysis, 3CL protease inhibitors significantly increased the rate of alleviation (HR 1.17; 95% CI [1.09;1.25]; p < 0.01), and recovery rates (HR 1.18; 95% CI [1.11;1.26]; p < 0.01) in patients with mild to moderate COVID-19. However, 3CL protease inhibitors significantly reduced viral load at 72 h (SMD − 0.95; 95% CI [-1.23; -0.66]; p < 0.01) compared with placebo in these patients. There was no significant difference between groups in symptomatic resolution (RR 1.01; 95% CI [1.00;1.03]; p = 0.147).
conclusion3CL protease inhibitors significantly reduced the change in the viral load and increased the rate of symptom alleviation and recovery, underscoring their importance as a potential therapeutic option.
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