The efficacy of antivirals, corticosteroids, and mAbs as acute COVID treatments in reducing the incidence of long COVID: a Systematic Review and meta-analysis.

ABSTRACT

BACKGROUND: Whether treatment during acute COVID results in protective efficacy against long COVID incidence remains unclear. OBJECTIVES: To assess the relationship between acute COVID treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms. DATA SOURCES Searches were conducted up to Jan 29, 2024 in PubMed, Medline, Web of Science, and Embase. STUDY ELIGIBILITY CRITERIA Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions. PARTICIPANTS: Patients with a COVID-19 diagnosis history. INTERVENTIONS: Patients treated with antivirals, corticosteroids or mAbs. ASSESSMENT OF RISK OF BIAS Quality assessment was based on Newcastle-Ottawa scale, ROBINS-I and Cochrane risk of bias tool. METHODS OF DATA SYNTHESIS: Basic characteristics were documented for each study. Random forest model and meta-regression was used to evaluate correlation between treatments and long COVID. RESULTS: Our search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID antiviral treatment concluded its protective efficacy against long COVID (OR 0.61, 95% CI 0.48-0.79, p = 0.0002); however, corticosteroid (OR 1.57, 95% CI 0.80-3.09, p = 0.1913) and mAbs treatments (OR 0.94, 95% CI 0.56-1.56, p = 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and non-diabetic populations. Furthermore, antivirals effectively reduced eight out of the twenty-two analyzed long COVID symptoms. DISCUSSION: Our meta-analysis determined that antivirals reduced long covid incidence across populations and should thus be recommended for acute COVID treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID corticosteroids' potential harmful effects on the post-acute phase of COVID.