Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis.

Methods

Systematic reviewand network meta-analysis.

系统综述和网络荟萃分析。

data_sources

Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE) by the Epistemonikos Foundation, a public, living repository of covid-19 articles, from 1 January 2023 to 19 May 2024.

由Epistemonikos基金会创建的Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE)，这是一个公开的、持续更新的covid-19文章库，涵盖的时间范围从2023年1月1日至2024年5月19日。

The search also included the WHO covid-19 database (up to 17 February 2023) and six Chinese databases (up to 20 February 2021).

搜索还涵盖了世界卫生组织的covid-19数据库（截至2023年2月17日）和六个中国数据库（截至2021年2月20日）。

The analysis included studies identified between 1 December 2019 and 28 June 2023.

分析包括了在2019年12月1日至2023年6月28日期间识别的研究。

study_selection

Randomised clinical trials in which people with suspected, probable, or confirmed mild or moderate covid-19 were allocated to drug treatment or to standard care or placebo.

在随机临床试验中，疑似、可能或确诊的轻度或中度COVID-19患者被分配接受药物治疗或标准护理或安慰剂。

Pairs of reviewers independently screened potentially eligible articles.

成对的评审员独立筛选可能符合条件的文章。

Methods

After duplicate data abstraction, a bayesian network meta-analysiswas conducted.

在数据提取重复后，进行了贝叶斯网络荟萃分析。

Risk of bias was assessed by use of a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach.

通过使用Cochrane风险偏倚2.0工具的修改版来评估偏倚风险，并使用 GRADE方法来评估证据的确定性。

For each outcome, following GRADE guidance, drug treatments were classified in groups from the most to the least beneficial or harmful.

根据GRADE指南，对每个结果，药物治疗被分类为从最有益到最有害的各个组别。

Results

Of 259 trials enrolling 166 230 patients, 187 (72%) were included in the analysis.

在纳入的259项试验中，共有166,230名患者参与，其中187项（占72%）被纳入分析。

Compared with standard care, two drugs probably reduce hospital admission: nirmatrelvir-ritonavir (25 fewer per 1000 (95% confidence interval28 fewer to 20 fewer), moderate certainty) and remdesivir (21 fewer per 1000 (28 fewer to 7 fewer), moderate certainty).

与标准治疗相比，两种药物可能降低住院率：奈玛特韦-利托那韦（每1000人减少25人（95%置信区间为28人减少至20人减少），中等确定性）和瑞德西韦（每1000人减少21人（28人减少至7人减少），中等确定性）。

Molnupiravir and systemic corticosteroids may reduce hospital admission (low certainty).

莫努匹韦和全身性皮质类固醇可能降低住院率（低确定性）。

Compared with standard care, azithromycin probably reduces time to symptom resolution (mean difference 4 days fewer (5 fewer to 3 fewer), moderate certainty) and systemic corticosteroids, favipiravir, molnupiravir, and umifenovir probably also reduce duration of symptoms (moderate to high certainty).

与标准治疗相比，阿奇霉素可能缩短症状缓解时间（平均差异减少4天（5天减少至3天减少），中等确定性），全身性皮质类固醇、法匹拉韦、莫努匹韦和乌米芬韦也可能缩短症状持续时间（中等到高确定性）。

Compared with standard care, only lopinavir-ritonavir increased adverse effects leading to discontinuation.

与标准治疗相比，仅洛匹那韦-利托那韦增加了导致停药的不良反应。

Conclusions

Nirmatrelvir-ritonavir and remdesivir probably reduce admission to hospital, and systemic corticosteroids and molnupiravir may reduce admission to hospital. Several medications including systemic corticosteroids and molnupiravir probably reduce time to symptom resolution.

奈玛特韦-利托那韦和瑞德西韦可能减少住院，全身性皮质类固醇和莫努匹韦可能减少住院。包括全身性皮质类固醇和莫努匹韦在内的几种药物可能缩短症状缓解时间。

systematic_review_registration

This review was not registered.

本综述未进行注册。

The protocol is publicly available in the supplementary material.

该方案的协议在补充材料中公开可查。