Pharmacological and Adjunctive Management of Non-Hospitalized COVID-19 Patients During the Omicron Era: A Systematic Review and Meta-Analysis.

INTRODUCTION

The emergence of SARS-CoV-2 Omicron subvariants characterized by increased transmissibility and immune escape has raised concerns about the efficacy of current treatments. This systematic review and meta-analysis evaluated pharmacological and non-pharmacological interventions in Omicron-infected non-hospitalized patients, focusing on key clinical outcomes such as hospitalization, respiratory failure, ICU admission, and 30-day mortality.

METHODS

Searches were performed in MEDLINE, EMBASE, Web of Science, Cochrane, and ClinicalTrials.gov (last update: 13 July 2025). Eligible studies reported outcomes on antiviral agents, monoclonal antibodies, adjunctive therapies, or telemedicine. Random-effects meta-analyses were conducted when appropriate, with heterogeneity assessed by I. Publication bias was evaluated via funnel plots and Egger's test. Subgroup analyses explored sources of heterogeneity.

RESULTS

Eighty-eight studies were included. Meta-analyses, comparing treatment vs. no treatment, revealed that nirmatrelvir/ritonavir reduced hospitalization by 52% (RR 0.48, 95% CI 0.36-0.63) and all-cause mortality by 84% (RR 0.16, 95% CI 0.11-0.24). Remdesivir reduced hospitalization by 70% (RR 0.30, 95% CI 0.19-0.47) and respiratory failure by 89% (RR 0.11, 95% CI 0.03-0.44). Sotrovimab decreased hospitalization (RR 0.71, 95% CI 0.54-0.93) and mortality (RR 0.34, 95% CI 0.19-0.61). Molnupiravir modestly reduced hospitalization (RR 0.80, 95% CI 0.70-0.91) and respiratory failure (RR 0.45, 95% CI 0.27-0.77).

CONCLUSIONS

Nirmatrelvir/ritonavir and remdesivir remain important for reducing severe outcomes, while sotrovimab retains partial efficacy. Rapid access to antivirals remains an important factor in mitigating SARS-CoV-2's burden.