| Objective: The purpose of this study is to explore the efficacy and safety differences of Fapilavir,Remdesivir,Abidol and Lopinavir/ritonavir in the treatment of different clinical types of COVID-19,and to explore the efficacy of abidol in the treatment of nonsevere COVID-19 patients and analyze its influencing factors,so as to provide reference for the selection of individualized antiviral drugs for COVID-19.Methods:（1）According to the established retrieval strategy and inclusion and exclusion criteria,the clinical research literature on the treatment of COVID-19 with four antiviral drugs was screened.Evaluate the quality of included literature and extract important information.Based on the principle of network meta-analysis,pairwise comparison forest plots and probability ranking plots were drawn to compare the efficacy and safety of the four antiviral drugs for all clinical types and mild/common types of COVID-19.（2）Based on the case data of COVID-19 patients in Wuhan Hanyang Guobo Shelter Hospital,the propensity score matching method was used to retrospectively analyze the efficacy of Arbidol on shortening nucleic acid negative conversion and hospitalization time in patients with non-severe COVID-19,and to explore the factors affecting the efficacy of Arbidol.Results:（1）Based on the results of all clinical typing analysis: in terms of effectiveness,except for the hospitalization time of remdesivir was better than that of lopinavir/ritonavir,none of the four antiviral drugs differed significantly in the time of nucleic acid conversion,chest CT improvement on the 14 th day,length of hospital stay,in-hospital death,and new need for mechanical ventilation/ECMO.The frequency of remdesivir as the optimal intervention was the highest.The safety evaluation results showed that In the incidence of any adverse reactions: fapiravir,lopinavir/ritonavir >Standardized supportive care.Lopinavir/ritonavir > Remdesivir;In the incidence of serious adverse reactions: fapilavir > Standardized supportive therapy,remdesivir;In the incidence of renal dysfunction: Arbidol,lopinavir/ritonavir > Fapilavir;In the incidence of gastrointestinal dysfunction;Lopinavir/ritonavir > Standardized supportive care.In addition to the above,there was no significant difference in other safety indicators in pairwise comparison of drugs.The frequency with the lowest incidence of adverse drug reactions in standardized supportive care was the highest.Based on the results of nonsevere type analysis,there was no statistical difference in the pairings,except that lopinavir/ritonavir was higher than Arbidol in the incidence of digestive tract abnormalities.（2）Retrospective study results showed that: in terms of nucleic acid conversion time:for COVID-19 patients of mild type,the Arbidor group was superior to the standardized support treatment group.For COVID-19 patients of common type,there was no statistical significance between the two groups;In terms of length of hospital stay: There was no statistical significance between the Arbidol group and the standardized supportive care group for patients with mild and common COVID-19.Univariate analysis showed that gender,age and complications had no statistically significant effect on the efficacy of Arbidol.Conclusions:（1）Overall,Fapilavir,Remdesivir,Abidol and Lopinavir/ritonavir monotherapy combined with standardized support therapy had no significant advantage in efficacy compared with standardized support therapy,and the incidence of adverse reactions was relatively high..Similarly,a retrospective analysis showed that arbidol combined with standardized support therapy had no significant advantage in shortening nucleic acid conversion and length of hospital stay for non-severe COVID-19.The four antiviral drugs mentioned above should be used with more caution in the clinical application of COVID-19. |
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