Which Drug Treatment Should Be Recommended for Patients Infected with COVID-19? A Systematic Review and Network Meta-Analysis

Background: Several potential antiviral agents are being given empirically to patients infected with coronavirus disease 2019 (COVID-19). We conducted this network meta-analysis (NMA) to distinguish antiviral treatments which was the most preferable than others. Method: Literature was systematically searched from databases. We included studies of drug therapy for COVID-19 patients. Effect size was presented as odds ratios (ORs) for dichotomous outcomes with 95% CIs. The ranking probabilities and surface under the cumulative ranking curve (SUCRA) were ascertained. The effectiveness outcome assessed was the viral clearance at 7 days, 14 days and survival rate. Results: Patients treated by hydroxychloroquine and azithromycin (OR = 36.16, 95% CI: 0.84-1555.63) was significantly associated with an increasing viral clearance at 7 days. Arbidol had better efficacy in increasing viral clearance at 14 days (OR = 3.28, 95% CI: 0.64-16.74). Arbidol and favipiravir significantly reduced the mortality for COVID-19 patients (Arbidol: OR = 3.27, 95% CI: 0.71-15.04; Favipiravir: OR = 1.71, 95% CI: 0.07- 39.32). Hydroxychloroquine and azithromycin ranked highest in clearing virus at 7 days (SUCRA= 94.0%), and arbidol ranked highest in clearing virus at 14 days and reducing the mortality. Conclusions: Arbidol appeared to be the most efficacious drug for against COVID-19 infection.Funding Statement: This study was supported by the key Laboratory of Neuropsychiatric Drug Research of Zhejiang Province [2019E10021], the Natural Science Foundation of Zhejiang Province [LQ20H250001] and funds from the Health Bureau of Zhejiang Province [2019RC091].Declaration of Interests: The authors declared no conflicts of interest in this study.