The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID: a systematic review and meta-analysis.

IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-12-01 Epub Date: 2024-07-14 DOI:10.1016/j.cmi.2024.07.006
Gangqiang Sun, Ke Lin, Jingwen Ai, Wenhong Zhang
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Abstract

Background: Whether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear.

Objectives: To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.

Methods: A systematic review and meta-analysis.

Data sources: Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.

Study eligibility criteria: Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions.

Participants: Patients with a COVID-19 diagnosis history.

Interventions: Patients treated with antivirals, corticosteroids or mAbs.

Assessment of risk of bias: Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.

Methods of data synthesis: Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the correlation between treatments and long COVID.

Results: Our search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID-19 antiviral treatment concluded its protective efficacy against long COVID (OR, 0.61; 95% CI, 0.48-0.79; p 0.0002); however, corticosteroid (OR, 1.57; 95% CI, 0.80-3.09; p 0.1913), and mAbs treatments (OR, 0.94; 95% CI, 0.56-1.56; p 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.

Conclusions: Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids' potential harmful effects on the post-acute phase of COVID-19.

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抗病毒药物、皮质类固醇激素和 mAbs 作为急性 COVID 治疗方法在降低长期 COVID 发生率方面的疗效:系统综述和荟萃分析。
背景:急性 COVID 期间的治疗是否会对长期 COVID 发病率产生保护作用仍不清楚:急性 COVID 期间的治疗是否会对长期 COVID 的发病率产生保护作用仍不清楚:评估抗病毒药物、皮质类固醇激素和单克隆抗体(mAbs)等急性COVID治疗与长期COVID发病率之间的关系,以及它们在不同人群和个体症状中的效果:研究资格标准:研究资格标准:报道急性 COVID 后长期 COVID 发病率的文章,随访至少 30 天,无语言限制:干预措施:干预措施:接受抗病毒药物、皮质类固醇或mAbs治疗的患者:质量评估基于纽卡斯尔-渥太华量表、ROBINS-I 和 Cochrane 偏倚风险工具:记录每项研究的基本特征。随机森林模型和元回归用于评估治疗与长COVID之间的相关性:我们的搜索发现了 2363 条记录,其中 32 条被纳入定性综合,25 条被纳入荟萃分析。14篇研究急性COVID抗病毒治疗的论文得出结论,抗病毒治疗对长COVID有保护作用(OR 0.61,95% CI:0.48-0.79,p = 0.0002);但皮质类固醇(OR 1.57,95% CI:0.80-3.09,p = 0.1913)和mAbs治疗(OR 0.94,95% CI:0.56-1.56,p = 0.8012)没有产生这种效果。随后的亚组分析表明,抗病毒药物对老年人、男性、未接种疫苗者和非糖尿病患者的保护作用更强。此外,抗病毒药物还有效减少了22种长期COVID症状中的8种:讨论:我们的荟萃分析表明,抗病毒药物可降低不同人群的长程COVID发病率,因此应推荐用于急性COVID的治疗。mAbs治疗与长COVID之间没有关系,但应开展研究以明确急性COVID皮质类固醇激素对COVID急性期后阶段的潜在有害影响。
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来源期刊
CiteScore
25.30
自引率
2.10%
发文量
441
审稿时长
2-4 weeks
期刊介绍: Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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