Effect of sofosbuvir-based treatment on clinical outcomes of patients with COVID-19: a systematic review and meta-analysis of randomised controlled trials

Objective This systematic review and meta-analysis examined the efficacy of sofosbuvir-based antiviral agents against coronavirus disease 2019 (COVID-19). Methods PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from inception to 15 August 2021. Studies comparing the clinical efficacy and safety of sofosbuvir-based antiviral regimens (study group) with other antivirals or standard of care (control group) in patients with COVID-19 were included. Results Overall, 687 patients with COVID-19 were included, of which 377 patients received sofosbuvir-based treatment. Mortality was lower in the study group than in the control group (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.30-0.79; I2 = 0%). The overall clinical recovery rate was higher in the study group than in the control group (OR, 1.82; 95% CI, 1.20-2.76; I2 = 28%). The study group presented a lower requirement for mechanical ventilation (OR, 0.33; 95% CI, 0.13-0.89; I2 = 0%) and intensive care unit (ICU) admission (OR, 0.42; 95% CI, 0.25-0.70; I2 = 0%) than the control group. Furthermore, the study group exhibited a shorter length of hospital stay (mean deviation [MD], -1.49; 95% CI, -2.62 to -0.37, I2 = 56%) and recovery time (MD, -1.34; 95% CI, -2.29, -0.38, I2 = 46%) than the control group. Conclusions Sofosbuvir-based treatment may help reduce mortality in patients with COVID-19 and improve associated clinical outcomes. Furthermore, sofosbuvir-based treatment was as safe as the comparator in patients with COVID-19. However, further large-scale study is warranted to validate these findings.