Safety and efficacy of different therapeutic regimens in Egyptian adults with moderate COVID-19 infection (EVEREST): a real-world retrospective study

DOI record: { "DOI": "10.1038/s41598-025-23660-1", "ISSN": [ "2045-2322" ], "URL": "http://dx.doi.org/10.1038/s41598-025-23660-1", "abstract": "<jats:title>Abstract</jats:title>\n <jats:p>This study seeks to disseminate insights from Egypt’s management of COVID-19 patients by evaluating the effectiveness and safety of various treatment regimens using combined repurposed antivirals. A retrospective cohort study was conducted on 310 moderate hospitalized COVID-19 cases. Patients were divided into four treatment arms: standard care, sofosbuvir/daclatasvir (sovodak) plus ivermectin, sofosbuvir/ledipasvir (SOF/LED) plus hydroxychloroquine, and SOF/LED plus ivermectin. The study analyzed parameters such as hospitalization days, total clinical recovery percentage, and progressive CT chest changes. The median hospitalization days significantly differed in arm 1 versus arms 2 and 3 (<jats:italic>p</jats:italic> &lt; 0.001 and <jats:italic>p</jats:italic> = 0.025, respectively). There was a difference between arms 1 and 4 in the days till clinical improvement (<jats:italic>p</jats:italic> = 0.007). Complete normalization of vital signs occurred in 26% of arm 4 patients versus 43% in arm 1 (<jats:italic>p</jats:italic> = 0.023), and a statistically significant difference in the proportion of patients with total clinical recovery was found between arms 1 and 2 (<jats:italic>p</jats:italic> = 0.009). All arms displayed a statistically significant lower proportion of patients with progressive CT scans compared to arm 1. Our study reveals that most tested antiviral combinations effectively reduced hospitalization days and progressive CT scans. These regimens demonstrated efficacy in treating moderate COVID-19 to prevent disease progression and complications.</jats:p>", "alternative-id": [ "23660" ], "article-number": "36477", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "13 August 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "8 October 2025" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "20 October 2025" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "The authors declare no competing interests." }, { "group": { "label": "Ethics approval", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "The study was conducted in accordance with the Declaration of Helsinki, and approved by the ethical committee office of the Medical Military Academy." }, { "group": { "label": "Consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "Informed consent was obtained from all subjects involved in the study." } ], "author": [ { "affiliation": [], "family": "Abdel-Salam Elgohary", "given": "Mohamed", "sequence": "first" }, { "ORCID": "https://orcid.org/0000-0001-8008-4598", "affiliation": [], "authenticated-orcid": false, "family": "Hamza", "given": "Nouran", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-7421-5085", "affiliation": [], "authenticated-orcid": false, "family": "Ali", "given": "Asmaa", "sequence": "additional" }, { "affiliation": [], "family": "Zaher Abdel-Rahman", "given": "Raafat", "sequence": "additional" }, { "affiliation": [], "family": "Thabet Elnagar", "given": "Mohamed", "sequence": "additional" }, { "affiliation": [], "family": "Emam Mohamed", "given": "Mohamed", "sequence": "additional" }, { "affiliation": [], "family": "Seadawy", "given": "Mohamed G.", "sequence": "additional" }, { "affiliation": [], "family": "Zenhom Abdelfatah", "given": "Mahmoud", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0001-5854-5984", "affiliation": [], "authenticated-orcid": false, "family": "Taha", "given": "Nouran A.", "sequence": "additional" }, { "affiliation": [], "family": "Rauof", "given": "Marina", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0001-6503-0719", "affiliation": [], "authenticated-orcid": false, "family": "El-Bouseary", "given": "Maisra M.", "sequence": "additional" } ], "container-title": "Scientific Reports", "container-title-short": "Sci Rep", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2025, 10, 20 ] ], "date-time": "2025-10-20T10:36:09Z", "timestamp": 1760956569000 }, "deposited": { "date-parts": [ [ 2025, 10, 20 ] ], "date-time": "2025-10-20T10:36:14Z", "timestamp": 1760956574000 }, "funder": [ { "name": "The Science, Technology & Innovation Funding Authority" } ], "indexed": { "date-parts": [ [ 2025, 10, 21 ] ], "date-time": "2025-10-21T00:35:17Z", "timestamp": 1761006917326, "version": "build-2065373602" }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2025, 10, 20 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2025, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 10, 20 ] ], "date-time": "2025-10-20T00:00:00Z", "timestamp": 1760918400000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 10, 20 ] ], "date-time": "2025-10-20T00:00:00Z", "timestamp": 1760918400000 } } ], "link": [ { "URL": "https://www.nature.com/articles/s41598-025-23660-1.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41598-025-23660-1", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41598-025-23660-1.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1038", "published": { "date-parts": [ [ 2025, 10, 20 ] ] }, "published-online": { "date-parts": [ [ 2025, 10, 20 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "key": "23660_CR1", "unstructured": "Dyer, P. 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