• Wei Liu, Pengxiang Zhou, Ken Chen, Zhikang Ye, Fang Liu, Xiaotong Li, Na He, Ziyang Wu, Qi Zhang, Xuepeng Gong, Qiyu Tang, Xin Du, Yingqiu Ying, Xiaohan Xu, Yahui Zhang, Jinyu Liu, Yun Li, Ning Shen, Rachel J Couban, Quazi I Ibrahim, Gordon Guyatt, and Suodi Zhai.
• Department of Pharmacy (W. Liu, Zhou, F. Liu, Li, He, Wu, Q. Zhang, Tang, Du, Ying, Xu, Y. Zhang, Li, Zhai), Peking University Third Hospital, Beijing, China; Institute for Drug Evaluation (Zhai, F. Liu), Departments of Pharmacy Administration and Clinical Pharmacy (Wu, Du, Y. Zhang), and Respiratory and Critical Care Medicine (Shen), Peking University Health Science Center, Beijing, China; College of Pharmacy (Chen), University of Nebraska Medical Center, Omaha, Neb.; Department of Health Research Methods, Evidence and Impact (Ye, Ibrahim, Guyatt), McMaster University, Hamilton, Ont.; Department of Pharmacy (Gong, J. Liu), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Pharmacy Department (Y. Li), First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
• CMAJ. 2020 Jul 6; 192 (27): E734-E744.

BackgroundAntiviral 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.MethodsWe 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.ResultsIn 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.InterpretationTo 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.© 2020 Joule Inc. or its licensors.

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