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Clinician Article

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Antiviral therapy in management of COVID-19: a systematic review on current evidence.

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• Yousefifard M
• Zali A
• Mohamed Ali K
• Madani Neishaboori A
• Zarghi A
• Hosseini M, et al.

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Clinical Comments

Anesthesiology

This is a review of published literature regarding antiviral treatment in COVID-19. As such, it is highly relevant to any healthcare provider. Unfortunately, the information available for review is scant and likely out of date. A manuscript like this one will be much more valuable in a year. At best, this shows the therapies that have been attempted for COVID-19 and will remind clinicians that no proven therapies are yet in existence.

Anesthesiology

This analysis presents a review of anti-viral therapy for the corona virus. Most practitioners know that no anti-viral therapy exists. However, the similarity of the virus to previous pandemics and the lack of response to research is surprising. The article is a call to investigate all viruses because it is unclear when it will reappear.

Cardiology

Necessary information. I am not an expert, but I'm unsure about the expansiveness of a Medline query that uses only free text search (tiab) and not both free text and MESH.

Emergency Medicine

This systematic review evaluates the efficacy of antivirals in COVID-19 and provides a summary of studies conducted for SARS-CoV-1 and MERS-CoV. The authors found only one clinical trial on the efficacy of antivirals for COVID-19, which demonstrated no benefit with lopinavir/ritonavir in terms of viral load or 28-day mortality. All other studies found in the literature review were case reports or case series. No studies were found evaluating lopinavir/ritonavir in SARS-CoV-1 or MERS-CoV. The authors call for further study of antivirals. This reflects the recently released IDSA guidelines.

Emergency Medicine

As an Emergency doc, I see patients and their families who are searching for something in which to hope. This analysis lays out what we have suspected - there is NO evidence pointing us one way or the other. I think it's useful information in order to care for patients without harming them.

Family Medicine (FM)/General Practice (GP)

This article has a very captivating title, "Antiviral Therapy in Management of COVID-19: a Systematic Review on Current Evidence." Their search strategy, however, reported finding only 1 clinical trial by their definition. This was the trial by Cao et al of "Lopinavir-Ritonavir" vs standard care (NEJM 2020). The reviewers misinterpret the lack of a statistically significant difference as being equivalent to "showing ineffectiveness." This is despite the mortality difference being -5.8% (95% CI = -17.3 to 5.7%).

General Internal Medicine-Primary Care(US)

Although this may not be new information, it is important for practitioners in many specialties. It should be distributed.

Geriatrics

Simply demonstrates the lack of published evidence on COVID-19 antiviral therapies, a situation that will change dramatically over ensuing months and years.

Hematology

Important because it destroys all the hype about promising therapies for COVID-19.

Hemostasis and Thrombosis

Seems like a nice summary. Impact is limited by the fact that COVID data changes daily, but methodologically looks reasonable.

Infectious Disease

Most of the info is known and none is new.

Intensivist/Critical Care

There is only one trial in this systematic review and the rest are case series, from which the review appropriately states you cannot discern any information.

Intensivist/Critical Care

Succinct review of the literature on anti-viral therapy for SARS COV-2. Most of the ongoing studies will shed significant light on potentially useful therapy.

Internal Medicine

This information was already leaked by the CDC and the results announced on CNN.

Internal Medicine

Although an extensive search for studies on anti-retroviral therapy for COVID-19 was performed, there are no RCTs that allow for us to make comfortable treatment decisions on patients with this condition, as we have known since the pandemic began.

Nephrology

I agree with the conclusion that "we" should be ready to implement trials since we know these will recur. In addition, cluster randomized trials could be done comparing states in the US who elect to use social distancing vs those who do not to gain more knowledge about whether or not such measures have a positive impact. We know they have a negative impact (economically). Ethically, don't we have an obligation to explore the benefits when we know there are harms?

Oncology - General

This review provides a good summary of the lack of high-quality research on antivirals in the management of COVID-19. That said, beyond highlighting the lack of evidence, it does not add much to management.

Pediatric Hospital Medicine

We are way too early in the pandemic for a systematic review of treatment options, so the limited findings of this article have no clinical relevance.

Pediatrics (General)

This is a rapidly changing climate. The information in this article is likely to be out-of-date quickly. This should be communicated with any update and notify information.

Pediatrics (General)

The timely study helps summarize current treatment options for CoVID 19. The lack of solid treatment should inform our public health measures.