BMJ

Meta-analysis examines efficacy of treatments for mild to moderate COVID-19

June 17, 2025

Study details: This systematic review and network meta-analysis included 187 randomized trials (out of 259 identified) enrolling 166,230 patients with suspected, probable, or confirmed mild or moderate COVID-19. The analysis compared drug treatments with standard care or placebo, using a Bayesian network meta-analysis and GRADE methodology to assess certainty of evidence and risk of bias.

Results: Nirmatrelvir-ritonavir and remdesivir probably reduce hospital admissions compared with standard care (absolute risk reductions: 25 and 21 fewer per 1,000, respectively; moderate certainty). Molnupiravir and systemic corticosteroids may also reduce hospital admissions, but with low certainty. Azithromycin probably shortens time to symptom resolution by a mean of 4 days, and several agents—including systemic corticosteroids, favipiravir, molnupiravir, and umifenovir—probably reduce symptom duration (moderate to high certainty). Lopinavir-ritonavir was the only drug associated with increased adverse effects leading to discontinuation.

Clinical impact: For patients with mild or moderate COVID-19, nirmatrelvir-ritonavir and remdesivir are the most evidence-supported options to reduce hospitalization risk. Molnupiravir and systemic corticosteroids may offer additional benefit, but with less certainty. Several agents, including systemic corticosteroids and molnupiravir, can modestly accelerate symptom resolution. These findings inform outpatient management strategies and highlight the need to balance efficacy with adverse effect profiles.

Source:

Ibrahim S, et al. (2025, May 29). BMJ. Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40441732/