Chinese expert consensus on the combined use of antiviral drugs for novel coronavirus infection

Abstract

The persistent mutation of the novel coronavirus (SARS-CoV-2) not only remains a threat to human health but also continues to challenge existing antiviral therapeutic strategies. In current clinical practice, the resistance of novel coronavirus to antivirals, the rebound of viral load after treatment with drugs such as nirmatrelvir/ritonavir (NTV/r), and the urgent need for rapid clearance of the virus in the management of critically and emergently ill patients suggest that the existing single-drug regimens may have limitations and that the intensity of suppression may be insufficient in some cases. In clinical practice, we have observed that a combination of antivirals with different mechanisms of action can result in better efficacy and not significantly increase adverse drug reactions (ADRs). For some immunosuppressed, post-transplantation, or other special patients in particular, such as those in whom COVID-19 nucleic acids tended not to be negative after conventional treatment, when virus clearance is still the main goal, the combination of small-molecule antivirals can help to clear the virus as early as possible and attempt to improve the success rate of salvage. Based on evidence-based medicine and in light of the current situation of China, we assembled experts from disciplines such as infectious diseases, respiratory medicine, critical care medicine, and clinical pharmacy into a group to carry out a systematic literature search and identify key issues and to put forward relevant recommendations to reach an Expert Consensus on Combined Use of Oral Small-molecule Antivirals to Treat COVID-19, which is intended to serve as a reference for clinical practice.