Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment

27 avril 2020

Source : Journal of International AIDS Society

Auteur : Enver Akalin and al.


ANALYSE:

Commentateur : Dr David REY.

Objectif :

  • Résumé de l’efficacité clinique des ARV sur les virus SARS, MERS et SARS-CoV-2

Principaux résultats :

  • Pas de bénéfice dans les essais randomisés, les études observationnelles ne sont pas concluantes.
  • Based on available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical out- comes in severe symptomatic disease or prevent infection among patients at high risk of acquiring COVID-19.

Conclusion : 

  • Pas d’efficacité démontrée des ARV sur SARS, MERS et COVID-19

Accédez à l’analyse complète ICI.

ABSTRACT :

Introduction:

Several antiretroviral drugs are being considered for the treatment of COVID-19, the disease caused by a newly identified coronavirus, (SARS-CoV-2). We systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials.

Methods:

Three databases were screened from inception to 30 March 2020 for studies reporting clinical outcomes of patients with SARS, MERS or COVID-19 treated with antiretrovirals.

Results:

From an initial screen of 433 titles, two randomized trials and 24 observational studies provided clinical outcome data on the use of antiretroviral drugs; most studies reported outcomes using LPV/r as treatment. Of the 21 observational studies reporting treatment outcomes, there were three studies among patients with SARS, six studies among patients with MERS and 12 studies among patients with COVID-19. In one randomized trial 99 patients with severe COVID-19 illness were randomized to receive LPV/r (400/100 mg twice a day) and 100 patients to standard of care for 14 days: LPV/r was not associated with a statistically significant difference in time to clinical improvement, although LPV/r given within 12 days of symptoms was associated with shorter time to clinical improvement; 28 day mortality was numerically lower in the LPV/r group (14/99) compared to the control group (25/100), but this difference was not statistically significant. The second trial found no benefit. The certainty of the evidence for the randomized trials was low. In the observational studies 3 out of 361 patients who received LPV/r died; the certainty of evidence was very low. Three studies reported a possible protective effect of LPV/r as post-exposure prophylaxis. Again, the certainty of the evidence was very low due to uncertainty due to limited sample size.

Conclusions:

On the basis of the available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical outcomes or prevent infection among patients at high risk of acquiring COVID-19.

Keywords: antiretroviral therapy; HIV; MERS; SARS; coronavirus; COVID-19


Télécharger l’article complet

© Les Hôpitaux Universitaires de Strasbourg 2020 - Tous droits réservés