Can antiviral drugs address the treatment challenges of severe fever with thrombocytopenia syndrome?- a systematic meta-analysis

Background: Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease with high mortality and severity rates. However, there is no clear treatment plan, specific effective antiviral drugs, or effective vaccine for SFTS. Recent studies have shown that the therapeutic effect of Ribavirin and other commonly used antiviral drugs such as Favipiravir (T-705), on SFTS is still controversial. This meta- analysis was conducted to evaluate the therapeutic efficacy of antiviral drugs on SFTS. Methods: Relevant studies were searched from Cochrane Library, Web of Science, Embase. and PubMed from inception to June 30, 2022, and updated to 2023. The study screening, data extraction, and quality assessment were conducted by re-searchers independently. A counterpart assessment tool was used to assess methodological quality, and the Stata15 software was employed to perform meta-analysis. Results: The meta-analysis included 8 studies consisting of 4692 patients. The results showed no significant difference in the mortality rate of SFTS patients between the antiviral drug group and the control group (HR: 0.85, 95% CI: 0.46-1.59, p = 0.618). Antiviral drugs had no noticeable effect on this disease (RR: 0.93, 95% CI: 0.58-1.48, p = 0.747). Conclusions: At present, antiviral drugs (Ribavirin and Favipiravir) used routinely in clinics show no positive effect on the treatment of SFTS yet and fail to reduce the mortality rate. On the other hand, clinical studies specifically evaluating viral load found that antiviral drugs were effective in the treatment of SFTS patients with low viral load, but the efficacy was not statistically significant.