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Objectives We aimed to determine to what extent systematic reviewers and post-preprint and post-publication peer review identified methodological and reporting issues in COVID-19 trials that could be easily resolved by the authors.Design Qualitative study.Data sources COVID-NMA living systematic review ( covid-nma.com), PubPeer, medRxiv, Research Square, SSRN.Methods We considered randomised controlled trials (RCTs) in COVID-NMA that evaluated pharmacological treatments for COVID-19 and retrieved systematic reviewers’ assessments of the risk of bias and outcome reporting bias. We also searched for commentary data on PubPeer and preprint servers up to 6 November 2023. We employed qualitative content analysis to develop themes and domains of methodological and reporting issues identified by commenters.Results We identified 500 eligible RCTs. Systematic reviewers identified methodological and reporting issues in 446 (89%) RCTs. In 391 (78%) RCTs, the issues could be easily resolved by the trial authors; issues included incomplete reporting (49%), selection of the reported results (52%) and no access to the pre-specified plan (25%). Alternatively, 74 (15%) RCTs had received at least one comment on PubPeer or preprint servers, totalling 348 comments. In 46 (9%) RCTs, the issues identified by post-preprint and post-publication peer review comments could be easily resolved by the trial authors; the issues were related to incomplete reporting (6%), errors (5%), statistical analysis (3%), inconsistent reporting of methods and analyses (2%), spin (2%), selection of the reported results (1%) and no access to the raw data/pre-specified plan (1%).Conclusions Without changing their process, systematic reviewers identified issues in most RCTs that could be easily resolved by the trial authors; however, the lack of an established author feedback mechanism represents a wasted opportunity for facilitating improvement and enhancing the overall manuscript quality. On the other hand, despite the existing feedback loop to authors present in post-publication peer review, it demonstrated limited effectiveness in identifying methodological and reporting issues.