Summary of findings for the main comparison. Antivirals compared with placebo/no treatment for infectious mononucleosis (glandular fever).
| Antivirals compared with placebo/no treatment for infectious mononucleosis (glandular fever) | ||||||
| Patient or population: patients diagnosed with clinical and laboratory‐confirmed diagnosis of infectious mononucleosis (glandular fever) Setting: hospitalised patients or outpatient setting Intervention: antivirals Comparison: placebo / no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with placebo/no treatment | Risk with antivirals | |||||
| Time to clinical recovery doctor judgement | The mean time to clinical recovery doctor judgement was 20 days | The mean time to clinical recovery doctor judgement in the intervention group was 5 days fewer (8.04 fewer to 1.08 fewer) | ‐ | 87 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | Statistically significant reduction in favour of treatment group. Andersson 1987 had 3 patients in the treatment group who had a co‐administered steroid whereas none of the placebo group had this |
| Time to clinical recovery patient judgement | The mean time to clinical recovery patient judgement was 42 days | The mean time to clinical recovery patient judgement in the intervention group was 6 days fewer (26.23 fewer to 15.05 more) | ‐ | 87 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | No statistically significant difference between groups. Andersson 1987 had 3 patients in the treatment group who had a co‐administered steroid whereas none of the placebo group had this |
| Adverse events and side effects | See comments | ‐ | 248 (5 RCTs) | ⊕⊝⊝⊝ VERY LOW 2 3 4 | Reported narratively only in five studies. In some reports authors were unsure whether adverse event was related to medication or complication of disease | |
| Duration of lymphadenopathy | The mean duration of lymphadenopathy was 41 days | The mean duration of lymphadenopathy in the intervention group was 9 days fewer (11.75 fewer to 6.14 fewer) | ‐ | 61 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 5 | Statistically significant difference in favour of treatment group. One study weighted very heavily due to high variance in other study |
| Development of complications of Infectious mononucleosis | see comments | ‐ | 108 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | Three studies reported complications narratively. There did not seem to be any difference in the incidence of complications between treatment and control groups | |
| Viral shedding | see comments | ‐ | 268 (6 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | Overall effect from all six studies was that viral shedding was suppressed while on antiviral treatment but this was not sustained when treatment stopped | |
| Days missing from school / work | The mean days missing from school / work was 20 days | Mean days missing from school/work in the intervention group was 1 day fewer (6.53 fewer to 4.74 more) | ‐ | 87 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 | No statistically significant difference between groups. Andersson 1987 had 3 patients in the treatment group who had a co‐administered steroid whereas none of the placebo group had this |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded two levels for imprecision where sample size was very small (< 200 participants)
2 Downgraded one level for risk of bias due to the majority of studies included in this outcome having an unclear or high risk of bias
3 Downgraded one level for indirectness as no study reported adverse events as a measurable outcome
4 Downgraded one level for imprecision due to small sample sizes or wide confidence intervals for this outcome
5 Downgraded one level for inconsistency due to wide variance of point estimates across studies and differences in setting, type of antiviral, or route of medication administration