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CONTEXTE : On donne de facon empirique des agents antiviraux a certains patients atteints de la maladie a coronavirus 2019 (COVID-19). Dans le but d'appuyer la redaction de lignes directrices sur la prise en charge de la COVID-19, nous avons realise une revue systematique des benefices et des prejudices associes a 7 traitements antiviraux contre cette infection. METHODES : Nous avons effectue des recherches dans MEDLINE, Embase, le Cochrane Central Register of Controlled Trials (CENTRAL), PubMed et 3 bases de donnees chinoises (CNKI, Wanfang Data et SinoMed) jusqu'au 19 avril 2020, dans medRxiv et ChinaXiv jusqu'au 27 avril 2020, ainsi que dans Chongqing VIP jusqu'au 30 avril 2020. Nous avons selectionne des etudes sur la ribavirine, la chloroquine, l'hydroxychloroquine, l'umifenovir (Arbidol), le favipiravir, l'interferon et le lopinavir/ritonavir. Lorsqu'il n'y avait pas de donnees directes d'etudes sur la COVID-19, nous avons retenu des donnees indirectes d'etudes sur le syndrome respiratoire aigu severe (SRAS) et le syndrome respiratoire du Moyen-Orient (SRMO) pour l'analyse de l'efficacite, et d'etudes sur d'autres infections respiratoires virales aigues pour l'analyse de l'innocuite. RESULTATS : Le taux de deces chez les patients atteints d'une forme sans signe clinique de gravite de COVID-19 etait extremement bas, ce qui ne permet pas de conclure a un effet important sur la mortalite. Nous n'avons obtenu que des donnees de tres faible qualite indiquant que la plupart des traitements avaient peu ou pas de benefices sur les parametres a l'etude, quelle que soit la gravite de la COVID-19. Seule exception : le traitement au lopinavir/ritonavir, pour lequel nous avons obtenu des donnees de faible qualite faisant etat d'une reduction de la duree du sejour en unite de soins intensifs (difference des risques [DR] 5 jours de moins, intervalle de confiance [IC] de 95 % 0 a 9 jours) et de la duree d'hospitalisation (DR 1 jour de moins, IC de 95 % 0 a 2 jours). En ce qui concerne l'innocuite, les donnees etaient de faible ou de tres faible qualite, sauf pour le traitement au lopinavir/ ritonavir, ou des donnees de qualite moyenne laissaient supposer une augmentation probable de la diarrhee, des nausees et des vomissements. INTERPRETATION : A l'heure actuelle, rien ne prouve de facon convaincante que les traitements antiviraux apportent des benefices importants dans la lutte contre la COVID-19, bien que les donnees propres a chaque traitement n'excluent pas cette possibilite. D'autres essais randomises et controles menes aupres de patients atteints de la COVID-19 sont necessaires avant de pouvoir recourir a ces traitements en toute confiance., Au 30 avril 2020, la maladie a coronavirus 2019 (COVID-19) (1) etait a l'origine de plus de 3 millions de cas d'infection et de plus de 210 000 deces dans [...]

BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes. RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting. INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence., As of Apr. 30, 2020, coronavirus disease 2019 (COVID-19) (1) has resulted in more than 3 million cases and more than 210 000 deaths worldwide. (2) The World Health Organization [...]

BACKGROUND:Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19.METHODS:We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes.RESULTS:In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting.INTERPRETATION:To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.

Reperfusion in ST-elevation myocardial infarction (STEMI) improves survival. Moreover, early reperfusion can abort the infarct and avoid significant myocardial necrosis. Yet, limited real world data exist and comparison between reperfusion strategies has not been established.