Abstract：
BACKGROUND: Whether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear.
OBJECTIVE: To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.
METHODS: A systematic review and meta-analysis.
METHODS: Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.
METHODS: Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions.
METHODS: Patients with a COVID-19 diagnosis history.
METHODS: Patients treated with antivirals, corticosteroids or mAbs.
UNASSIGNED: Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.
UNASSIGNED: Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the 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-19 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 nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.
CONCLUSIONS: Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids\' potential harmful effects on the post-acute phase of COVID-19.
OBJECTIVE: To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.
METHODS: A systematic review and meta-analysis.
METHODS: Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.
METHODS: Articles that reported long COVID incidence post-acute COVID with a follow-up of at least 30 days with no language restrictions.
METHODS: Patients with a COVID-19 diagnosis history.
METHODS: Patients treated with antivirals, corticosteroids or mAbs.
UNASSIGNED: Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.
UNASSIGNED: Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the 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-19 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 nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.
CONCLUSIONS: Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids\' potential harmful effects on the post-acute phase of COVID-19.
摘要：
背景：急性COVID期间的治疗是否能对长期COVID发病率产生保护作用尚不清楚。
目的：评估抗病毒药物急性COVID治疗之间的关系，皮质类固醇,单克隆抗体（mAb）和长期COVID发病率，以及它们对不同人群和个体症状的影响。
方法：直到2024年1月29日在PubMed进行了搜索，Medline,WebofScience,和Embase。
方法：报道急性COVID后COVID长期发病率的文章，随访至少30天，无语言限制。
方法：有COVID-19诊断史的患者。
方法：接受抗病毒药物治疗的患者，皮质类固醇或单克隆抗体。
■质量评估基于纽卡斯尔-渥太华量表，ROBINS-I和Cochrane偏差工具的风险。
■记录每个研究的基本特征。随机森林模型和元回归用于评估治疗与长期COVID之间的相关性。
结果：我们的搜索确定了2363条记录，其中32项纳入定性综合，25项纳入荟萃分析。来自14篇研究急性COVID抗病毒治疗的论文的效果大小得出结论，其对长期COVID的保护功效(OR0.61，95%CI：0.48-0.79，p=0.0002)；然而，皮质类固醇(OR1.57,95%CI:0.80-3.09,p=0.1913)和mAb治疗(OR0.94,95%CI:0.56-1.56,p=0.8012)未产生这种效果.随后的亚组分析显示，抗病毒药物在老年人中提供了更强的保护，男性,未接种疫苗和非糖尿病人群。此外，抗病毒药物有效地减少了22例分析的长期COVID症状中的8例。
结论：我们的荟萃分析确定，抗病毒药物降低了人群的长期covid发病率，因此应推荐用于急性COVID治疗。单克隆抗体治疗与长期COVID之间没有关系，但应进行研究以阐明急性COVID皮质类固醇对COVID急性期的潜在有害影响。
目的：评估抗病毒药物急性COVID治疗之间的关系，皮质类固醇,单克隆抗体（mAb）和长期COVID发病率，以及它们对不同人群和个体症状的影响。
方法：直到2024年1月29日在PubMed进行了搜索，Medline,WebofScience,和Embase。
方法：报道急性COVID后COVID长期发病率的文章，随访至少30天，无语言限制。
方法：有COVID-19诊断史的患者。
方法：接受抗病毒药物治疗的患者，皮质类固醇或单克隆抗体。
■质量评估基于纽卡斯尔-渥太华量表，ROBINS-I和Cochrane偏差工具的风险。
■记录每个研究的基本特征。随机森林模型和元回归用于评估治疗与长期COVID之间的相关性。
结果：我们的搜索确定了2363条记录，其中32项纳入定性综合，25项纳入荟萃分析。来自14篇研究急性COVID抗病毒治疗的论文的效果大小得出结论，其对长期COVID的保护功效(OR0.61，95%CI：0.48-0.79，p=0.0002)；然而，皮质类固醇(OR1.57,95%CI:0.80-3.09,p=0.1913)和mAb治疗(OR0.94,95%CI:0.56-1.56,p=0.8012)未产生这种效果.随后的亚组分析显示，抗病毒药物在老年人中提供了更强的保护，男性,未接种疫苗和非糖尿病人群。此外，抗病毒药物有效地减少了22例分析的长期COVID症状中的8例。
结论：我们的荟萃分析确定，抗病毒药物降低了人群的长期covid发病率，因此应推荐用于急性COVID治疗。单克隆抗体治疗与长期COVID之间没有关系，但应进行研究以阐明急性COVID皮质类固醇对COVID急性期的潜在有害影响。
