[论文解读] Comparative efficacy and safety of pharmacological interventions for the treatment of long COVID in adults: a systematic review and network meta-analysis

Hailu Zhou, Fei Jiang+1 more|arXiv (Cornell University)|Jan 17, 2026

Long-Term Effects of COVID-19被引用 0

一句话总结

本研究对成人长期新冠的药物治疗进行系统综述和网络元分析，概述在死亡率、住院、ICU 入院、机械通气、症状康复以及安全性方面的疗效。它识别出在特定症状和血栓风险方面可能受益的若干药物。

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, represents a major global pandemic of the 21st century, with long-term effects termed long COVID. This systematic review and network meta-analysis (NMA) evaluated pharmacological interventions for adults with long COVID, incorporating randomized controlled trials and adjusted observational studies. Primary outcomes included all-cause mortality, hospitalization, ICU admission, and mechanical ventilation; secondary outcomes covered symptom recovery across five categories, with safety assessed via adverse events. Results from random-effects models showed that saline nasal irrigation (SMD=21.10, 95% CI [16.91, 25.30]), nitrilotriacetic acid trisodium (SMD=7.40 [5.79, 9.01]), tetra sodium pyrophosphate (SMD=3.69 [2.61, 4.77]), and sodium gluconate (SMD=3.01 [1.92, 4.09]) significantly improved anosmia versus control. For thrombosis, rivaroxaban reduced arterial (OR=0.33 [0.01, 8.19]) and venous thrombotic events (OR=0.12 [0.01, 0.97]), while therapeutic-dose anticoagulants lowered thrombotic risks but increased major bleeding events (OR=1.86 [1.19, 2.89]) compared to prophylactic dosing. This NMA provides comparative evidence to guide treatment strategies for long COVID, highlighting the need for further research as new evidence emerges.

研究动机与目标

• Assess the comparative efficacy of pharmacological interventions for adults with long COVID across key clinical outcomes.
• Evaluate safety profiles and adverse events of these pharmacological options.
• Synthesize randomized and adjusted observational evidence to guide treatment strategies.
• Highlight areas where evidence is strong or sparse to inform future research.

提出的方法

• Perform a systematic review and network meta-analysis including randomized controlled trials and adjusted observational studies.
• Use random-effects models to estimate effects on primary outcomes: all-cause mortality, hospitalization, ICU admission, and mechanical ventilation.
• Assess secondary outcomes focusing on symptom recovery across five categories and safety via adverse events.
• Quantify treatment effects using standardized mean differences for symptom outcomes and odds ratios for binary clinical events.
• Incorporate heterogeneity and bias considerations inherent to mixed study designs.

实验结果

研究问题

• RQ1 What is the comparative efficacy of pharmacological interventions for reducing mortality, hospitalization, ICU admission, and mechanical ventilation in adults with long COVID?
• RQ2 Which pharmacological treatments show the strongest evidence for improving symptom recovery across predefined categories?
• RQ3 What are the safety profiles and adverse event risks associated with these pharmacological options, including major bleeding and thrombotic events?
• RQ4 How do therapeutic-dose anticoagulants compare to prophylactic dosing in terms of thrombotic risk and major bleeding?
• RQ5 What gaps in evidence remain to guide future research on long COVID pharmacotherapy?

主要发现

• Saline nasal irrigation significantly improved anosmia versus control (SMD 21.10; 95% CI 16.91 to 25.30).
• Nitrilotriacetic acid trisodium significantly improved anosmia versus control (SMD 7.40; 95% CI 5.79 to 9.01).
• Tetra sodium pyrophosphate significantly improved anosmia versus control (SMD 3.69; 95% CI 2.61 to 4.77).
• Sodium gluconate significantly improved anosmia versus control (SMD 3.01; 95% CI 1.92 to 4.09).
• Rivaroxaban reduced arterial thrombotic events (OR 0.33; 95% CI 0.01 to 8.19) and venous thrombotic events (OR 0.12; 95% CI 0.01 to 0.97).
• Therapeutic-dose anticoagulants lowered thrombotic risks but increased major bleeding events (OR 1.86; 95% CI 1.19 to 2.89).