Early use of oral antiviral drugs and the risk of post COVID-19 syndrome: a systematic review and network meta-analysis, 2024, Juan Jiang et al

Highlights

• First network meta-analysis of oral antiviral drugs effects on post COVID-19 condition (PCC).
• Early use of oral antiviral drugs in acute phase of COVID-19 has a protective effect against PCC.
• Nirmatrelvir-ritonavir may be a superior choice over molnupiravir on reducing risk of PCC.

Abstract
Objectives
This study aimed to determine the association of early use of oral antiviral drugs (including nirmatrelvir-ritonavir and molnupiravir) with the risk of PCC and compare the possible efficacy of nirmatrelvir-ritonavir and molnupiravir.
Methods
PubMed, Web of Science, Embase, Cochrane, MedRxiv, and Psycinfo were searched from inception until November 1, 2023. We included studies that assessed the effect of oral antiviral drugs on the incidence of PCC. Pairwise and network meta-analyses were conducted using a random-effects model. Risk ratios (RRs) for oral antiviral drugs were calculated with a CI.
Results
Nine observational studies containing 866,066 patients were included, in which nirmatrelvir-ritonavir and molnupiravir were evaluated in eight and two studies respectively, with both drugs evaluated in one study. Pair-wise meta-analysis showed that early oral antiviral drugs reduced PCC risk (RR 0.77, 95% CI 0.68–0.88). Network meta-analysis showed that nirmatrelvir-ritonavir may perform better than molnupiravir (surface under the cumulative ranking curve: 95.5% vs. 28.8%) at reducing PCC risk.
Conclusions
Early use of oral antiviral drugs may potentially protect against developing PCC sequelae in non-hospitalized patients with COVID-19. These findings support the standardized administration of oral antiviral drugs in patients during the acute phase of COVID-19 according to the guidelines.

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Early use of antivirals linked to reduce risk of long Covid

Though the protective mechanisms are not fully understood, the authors said lowering the rate of viral replication in patients likely plays a role in the antivirals' ability to lower the risk of long COVID. The condition is strongly associated with severe disease and hospitalization, and antivirals limit viral progression, they said.

"Our study underscores the importance of timely antiviral intervention in mitigating the long-term repercussions of COVID-19," the authors wrote.

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