The effect of antivirals on COVID-19: a systematic review

Expert Rev Anti Infect Ther. 2021 Apr;19(4):473-486. doi: 10.1080/14787210.2021.1823832. Epub 2020 Oct 20.


Introduction: Coronavirus Disease 2019 is a contagious infection that has infected millions worldwide. The objective of this systematic review is to identify studies pertaining to antivirals, both as sole and combined therapies, in COVID-19 patients and review the clinical outcomes of these treatment methods.

Areas covered: A systematic review was conducted using Preferred Reporting Items or Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was done on Medline, Global Health, and EMBASE using keywords and MeSH terms relevant to COVID- 19 and antivirals. Limits were put on date to obtain articles between December 2019 to May 2020 (the time at which the search was performed). 776 articles were identified and screened. After screening, 16 studies were included. The narrative synthesis revealed three key themes (1) Use of antivirals only (such as lopinavir, umifenovir, and remdesivir), (2) Use of lopinavir-ritonavir alongside other treatments, and (3) Use of other antivirals in combination with other treatments.

Expert opinion: Using antivirals in combination with other treatments has potential; however, further randomized controlled trials with larger sample sizes are required to identify the best candidate components that should comprise combined treatments for COVID-19. This should optimize treatment efficacy and improve patient outcomes.

Keywords: COVID-19; antiviral; coronavirus; treatment.

Publication types

  • Systematic Review

MeSH terms

  • Adenosine Monophosphate / administration & dosage
  • Adenosine Monophosphate / analogs & derivatives
  • Alanine / administration & dosage
  • Alanine / analogs & derivatives
  • Antiviral Agents / administration & dosage*
  • COVID-19 / diagnosis
  • COVID-19 / drug therapy*
  • COVID-19 / epidemiology*
  • Clinical Trials as Topic / methods
  • Drug Therapy, Combination
  • Humans
  • Ritonavir / administration & dosage
  • Treatment Outcome


  • Antiviral Agents
  • remdesivir
  • Adenosine Monophosphate
  • Ritonavir
  • Alanine