Supplementary Data — Nasopharyngeal/oropharyngeal treatment for COVID-19: real-time meta-analysis of 42 studies

0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Mohamed (RCT) 86% 0.14 [0.01-2.21] viral+ 0/5 3/5 Improvement, RR [CI] Treatment Control Mukhtar (RCT) 86% 0.14 [0.01-2.69] death 0/46 3/46 CT​2 Mukhtar (RCT) 86% 0.14 [0.01-2.69] ventilation 0/46 3/46 CT​2 Mukhtar (RCT) 18% 0.82 [0.63-1.07] viral+ 28/43 35/44 CT​2 Mukhtar (RCT) 14% 0.86 [0.76-0.98] viral+ 37/43 44/44 CT​2 Choudhury (RCT) 88% 0.12 [0.03-0.50] death 2/303 17/303 Choudhury (RCT) 84% 0.16 [0.09-0.28] hosp. 12/303 77/303 Choudhury (RCT) 96% 0.04 [0.02-0.07] viral+ 8/303 213/303 Guenezan (RCT) 63% 0.37 [0.06-1.63] viral load 12 (n) 12 (n) Jayaraman 50% 0.50 [0.23-1.08] viral+ 3/6 6/6 Short term viral Winchester (DB RCT) 42% 0.58 [0.36-0.94] no improv. 8/15 23/25 Winchester (DB RCT) 51% 0.49 [0.32-0.75] viral load 40 (n) 40 (n) Aref (RCT) 63% 0.37 [0.22-0.61] recov. time 57 (n) 57 (n) Aref (RCT) 56% 0.44 [0.29-0.66] recov. time 57 (n) 57 (n) Aref (RCT) 69% 0.31 [0.17-0.56] recov. time 57 (n) 57 (n) Aref (RCT) 64% 0.36 [0.21-0.60] recov. time 57 (n) 57 (n) Aref (RCT) 79% 0.21 [0.07-0.71] viral+ 3/57 14/57 Aref (RCT) 36% 0.64 [0.52-0.80] viral time 57 (n) 57 (n) Campione 47% 0.53 [0.38-0.72] viral time 32 (n) 32 (n) Campione 56% 0.44 [0.29-0.66] viral time 32 (n) 28 (n) Pablo-Marcos 29% 0.71 [0.32-1.56] viral load 31 (n) 40 (n) Pablo-Marcos 9% 0.91 [0.20-4.16] viral load 31 (n) 40 (n) Yilmaz (SB RCT) 86% 0.14 [0.01-2.65] hosp. 0/30 3/30 Yilmaz (SB RCT) 62% 0.4 [0.00-2e+04] viral load 30 (n) 30 (n) Yilmaz (SB RCT) 43% 0.6 [0.00-2e+06] viral load 30 (n) 30 (n) Poleti (DB RCT) 29% 0.71 [0.53-0.96] no recov. 29/59 52/75 Poleti (DB RCT) 22% 0.78 [0.63-0.97] no recov. 38/59 62/75 Poleti (DB RCT) 46% 0.54 [0.30-0.98] no recov. 12/59 28/75 Poleti (DB RCT) 32% 0.68 [0.42-1.09] no recov. 17/59 32/75 Sulistyani (SB RCT) 6% 0.94 [0.45-1.96] viral load 15 (n) 15 (n) Sulistyani (SB RCT) 11% 0.89 [0.42-1.88] viral load 15 (n) 15 (n) Elsersy (DB RCT) 91% 0.09 [0.01-1.62] hosp. 0/100 5/100 CT​2 Elsersy (DB RCT) 15% 0.85 [0.76-0.96] recov. time 100 (n) 100 (n) CT​2 Elsersy (DB RCT) 49% 0.51 [0.42-0.62] recov. time 100 (n) 100 (n) CT​2 Elsersy (DB RCT) 48% 0.52 [0.43-0.63] recov. time 100 (n) 100 (n) CT​2 Elsersy (DB RCT) 68% 0.32 [0.22-0.49] viral+ 21/100 65/100 CT​2 Elsersy (DB RCT) 90% 0.10 [0.01-0.77] viral+ 1/100 10/100 CT​2 Elsersy (DB RCT) 29% 0.71 [0.62-0.81] viral+ 70/100 99/100 CT​2 Elsersy (DB RCT) 92% 0.08 [0.05-0.14] transmission 12/194 173/227 CT​2 Elsersy (DB RCT) 94% 0.06 [0.03-0.12] transmission 8/194 157/227 CT​2 Panatto (RCT) 37% 0.63 [0.12-3.38] progression 2/20 3/19 Panatto (RCT) 85% 0.15 [0.01-2.65] progression 0/18 3/19 Panatto (RCT) 67% 0.33 [0.06-1.83] progression 2/38 3/19 Panatto (RCT) 29% 0.71 [0.54-0.93] viral+ 34 (n) 15 (n) Panatto (RCT) 30% 0.70 [0.56-0.88] viral+ 34 (n) 15 (n) Tandon (DB RCT) 68% 0.32 [0.09-1.12] no improv. 3/64 10/69 Tandon (DB RCT) 67% 0.33 [0.11-0.97] no improv. 4/64 13/69 Tandon (DB RCT) 42% 0.58 [0.33-1.01] no improv. 14/64 26/69 Tandon (DB RCT) 22% 0.78 [0.32-1.89] no improv. 8/105 10/102 Tandon (DB RCT) 18% 0.82 [0.39-1.75] no improv. 11/105 13/102 Tandon (DB RCT) 9% 0.91 [0.60-1.38] no improv. 30/105 32/102 Tandon (DB RCT) 20% 0.80 [0.75-0.86] viral load 64 (n) 69 (n) Tandon (DB RCT) 14% 0.86 [0.83-0.90] viral load 105 (n) 102 (n) Tandon (DB RCT) 26% 0.74 [0.52-1.05] viral time 64 (n) 69 (n) Tandon (DB RCT) 6% 0.94 [0.70-1.25] viral time 105 (n) 102 (n) ACCROS-I Valerio-.. (DB RCT) 61% 0.39 [0.24-0.63] no recov. 61 (n) 40 (n) ACCROS-I Valerio-.. (DB RCT) 67% 0.33 [0.09-1.24] no recov. 3/61 6/40 ACCROS-I Valerio-.. (DB RCT) 89% 0.11 [0.01-0.87] no recov. 1/61 6/40 ACCROS-I Valerio-.. (DB RCT) 53% 0.47 [0.22-1.02] no recov. 10/61 14/40 ACCROS-I Valerio-.. (DB RCT) 67% 0.33 [0.06-1.71] no recov. 2/61 4/40 ACCROS-I Valerio-.. (DB RCT) 59% 0.41 [0.14-1.16] no recov. 5/61 8/40 ACCROS-I Valerio-.. (DB RCT) 74% 0.26 [0.12-0.58] PASC 55 (n) 46 (n) ACCROS-II Valerio-Pascua 54% 0.46 [0.36-0.58] recov. time 330 (n) 330 (n) Karaaltin (RCT) 83% 0.17 [0.05-0.62] viral load 30 (n) 30 (n) Karaaltin (RCT) 86% 0.14 [0.05-0.46] viral load 30 (n) 30 (n) Karaaltin (RCT) 82% 0.18 [0.02-1.71] viral load 30 (n) 30 (n) Karaaltin (RCT) 91% 0.09 [0.03-0.30] viral load 30 (n) 30 (n) Matsuyama (RCT) 69% 0.31 [0.10-0.93] viral+ 4/139 13/140 Matsuyama (RCT) 38% 0.62 [0.42-0.92] viral+ 139 (n) 140 (n) Sanchez-.. (DB RCT) 87% 0.13 [0.01-2.46] hosp. 0/32 2/13 Bryan (DB RCT) -1% 1.01 [0.21-4.95] progression 3/261 3/263 Bryan (DB RCT) 11% 0.89 [0.71-1.11] recov. time 261 (n) 263 (n) Jing (DB RCT) 79% 0.21 [0.11-0.39] OGD 10/120 56/140 OGD CT​2 Jing (DB RCT) 97% 0.03 [0.00-0.57] severe case 0/120 15/140 CT​2 Jing (DB RCT) 95% 0.05 [0.00-0.78] severe case 0/120 11/140 CT​2 Jing (DB RCT) 83% 0.17 [0.02-1.34] severe case 1/120 7/140 CT​2 SeaCare de Gabory (RCT) 75% 0.25 [0.12-0.54] progression 7/82 31/91 SeaCare de Gabory (RCT) 68% 0.32 [0.15-0.71] progression 7/82 24/91 SeaCare de Gabory (RCT) 35% 0.65 [0.27-1.57] progression 7/82 12/91 SeaCare de Gabory (RCT) 24% 0.76 [0.60-0.96] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 17% 0.83 [0.76-0.91] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 26% 0.74 [0.57-0.97] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 29% 0.71 [0.57-0.87] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 26% 0.74 [0.61-0.92] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 14% 0.86 [0.68-1.09] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 11% 0.89 [0.70-1.13] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) -2% 1.02 [0.80-1.29] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 25% 0.75 [0.56-0.99] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 3% 0.97 [0.77-1.21] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 14% 0.86 [0.68-1.09] recov. time 82 (n) 91 (n) SeaCare de Gabory (RCT) 37% 0.63 [0.19-2.09] viral+ 4/82 7/91 Friedland (DB RCT) 60% 0.40 [0.18-0.93] viral load 10 (n) 13 (n) Friedland (DB RCT) 52% 0.48 [0.25-0.92] viral load 10 (n) 13 (n) Ponphaib.. (DB RCT) 36% 0.64 [0.46-0.89] no recov. 25/53 42/57 CT​2 Ponphaib.. (DB RCT) 24% 0.76 [0.64-0.89] no recov. 43/59 55/57 CT​2 Ponphaib.. (DB RCT) 14% 0.86 [0.77-0.97] no recov. 50/59 56/57 CT​2 Ponphaib.. (DB RCT) 30% 0.70 [0.59-0.84] no recov. 40/59 55/57 CT​2 Carvallo 96% 0.04 [0.00-0.63] cases 0/131 11/98 see notes CT​2 Carvallo 100% 0.00 [0.00-0.02] cases 0/788 237/407 see notes CT​2 Chahla (RCT) 95% 0.05 [0.00-0.80] m/s case 0/117 10/117 CT​2 Chahla (RCT) 84% 0.16 [0.04-0.46] cases 4/117 25/117 CT​2 Reznikov 45% 0.55 [0.32-0.94] cases n/a n/a Reznikov 59% 0.41 [0.25-0.68] cases n/a n/a Reznikov 29% 0.71 [0.44-1.15] cases n/a n/a Seet (CLUS. RCT) 45% 0.55 [0.38-0.80] symp. case 42/735 64/619 OT​1 Seet (CLUS. RCT) 31% 0.69 [0.52-0.92] cases 338/735 433/619 OT​1 CARR-COV-02 Figueroa (DB RCT) 80% 0.20 [0.05-0.78] symp. case 2/196 10/198 Shmuel 76% 0.24 [0.06-0.93] cases 2/83 16/160 Almanza-R.. (RCT) 94% 0.06 [0.02-0.25] cases 2/114 33/117 Almanza-R.. (RCT) 49% 0.51 [0.33-0.81] misc. 21/114 42/117 Brito-Reia 54% 0.46 [0.20-1.08] cases 6/1,153 44/3,887 Gutiérrez-G.. (RCT) 91% 0.09 [0.01-0.72] symp. case 1/84 10/79 Miller 75% 0.25 [0.14-0.43] cases 13/203 108/422 Amoah 93% 0.07 [0.00-1.13] cases 94 (n) 372 (n) Amoah 93% 0.07 [0.00-1.25] cases 0/94 10/372 Amoah 98% 0.0 [0.00-7e+04] cases 0/8 62/458 Wang 34% 0.66 [0.55-0.80] cases 44/70 343/362 Song (SB RCT) 81% 0.19 [0.08-0.48] symp. case 824 (n) 299 (n) Song (SB RCT) 62% 0.38 [0.23-0.62] cases 824 (n) 299 (n) Daneshfard (RCT) 34% 0.66 [0.49-0.89] symp. case 37/89 53/84 CT​2 Daneshfard (RCT) 97% 0.03 [0.00-0.19] symp. case 1/89 35/84 CT​2 Daneshfard (RCT) 66% 0.34 [0.11-1.04] symp. case 4/89 11/84 CT​2 Daneshfard (RCT) 62% 0.38 [0.12-1.16] symp. case 4/89 10/84 CT​2 Daneshfard (RCT) 26% 0.74 [0.50-1.09] symp. case 29/89 37/84 CT​2 Daneshfard (RCT) -6% 1.06 [0.43-2.62] symp. case 9/89 8/84 CT​2 Daneshfard (RCT) 79% 0.21 [0.07-0.59] symp. case 4/89 18/84 CT​2 Daneshfard (RCT) 76% 0.24 [0.09-0.60] symp. case 5/89 20/84 CT​2 Daneshfard (RCT) 98% 0.02 [0.00-0.31] symp. case 0/89 25/84 CT​2 Si 78% 0.22 [0.10-0.48] cases 3,368 (all patients) Karami (DB RCT) 45% 0.55 [0.24-1.22] symptoms 40 (n) 40 (n) Karami (DB RCT) 43% 0.57 [0.17-1.99] symptoms 36 (n) 40 (n) Karami (DB RCT) 42% 0.58 [0.22-1.51] symptoms 36 (n) 40 (n) Karami (DB RCT) 79% 0.21 [0.04-0.97] symptoms 36 (n) 40 (n) Karami (DB RCT) 18% 0.82 [0.22-2.96] symptoms 36 (n) 40 (n) Karami (DB RCT) 39% 0.61 [0.33-1.12] cases 11/40 18/40 Nasopharyngeal/oropharyngeal treatment COVID-19 outcomes c19early.org January 2026 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors naso/oropharyngeal Favors control
Fig. S1. All outcomes.
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Fig. S2. Comparison of results for RCTs versus observational studies. For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.