Efficacy of Early Treatment with Favipiravir on Disease Progression among High Risk COVID-19 Patients: A Randomized, Open-Label Clinical Trial
Dr Chuan Huan, Chuah, Chow Ting Soo, Hor Chee Peng, Joo Thye, Cheng, Hong Bee, Ker, Heng Gee, Lee, Kok Soon, Tiang Koi, Ng, Abdul Suhaila, Wahab, Nurul Ashikin, Tee Tze Yuan, Su Miin, Ong, Chidambaram Suresh Kumar, Malaysian Favipiravir, Study Group
doi:10.1093/cid/ciab962/6432025
Role of favipiravir remains uncertain in COVID-19. Early treatment with five days oral favipiravir did not prevent disease progression from non-hypoxia to hypoxia in high-risk patients. No beneficial effects were observed in preventing mechanical ventilation, ICU admission, and in-hospital mortality.
A c c e p t e d M a n u s c r i p t 18 moderate to severe diseases. All the recruited patients had risk factors for disease progression and half had evidence of COVID-19 pneumonia. Up to 97.4% of subjects completed the study with outcomes available for evaluation. Patients in intervention group received adequate dosing and duration of favipiravir before the occurrence of clinical deterioration around 4.5 (8.72 ) days from the study enrolment. The use of disease-modifying therapies which could improve clinical outcomes were also equal in both groups.
CONCLUSION Favipiravir did not exert any beneficial effect in preventing clinical deterioration from non-hypoxia to hypoxia among COVID-19 patients with co-morbidity. There was also no effect in reducing incidences of mechanical ventilation, ICU admission, and mortality during hospitalization.
ACKNOWLEDGEMENT The authors would like to thank researchers from all 14 designated COVID-19 public hospitals and Institute for Clinical Research for the contribution in this study. We are grateful of participation from all our patients. We also thank the Director-General of Health Malaysia for his permission to publish this study.
Members of the Malaysian Favipiravir Study
References
Beigel, Tomashek, Dodd, Remdesivir for the Treatment of Covid-19 -Final Report, New England Journal of Medicine
Cai, Yang, Liu, Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study
Cevik, Tate, Lloyd, Maraolo, Schafers et al., SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis, The Lancet Microbe
Chen, Zhang, Huang, Favipiravir versus Arbidol for COVID-19: A Randomized Clinical Trial
Covid, Molnupiravir reduces risk of hospital admission or death by 50% in patients at risk
Dabbous, Abd-Elsalam, El-Sayed, Efficacy of favipiravir in COVID-19 treatment: a multi-center randomized study, Arch Virol
Doi, Hibino, Hase, A Prospective, Randomized, Open-Label Trial of Early versus Late Favipiravir Therapy in Hospitalized Patients with COVID-19, Antimicrob Agents Chemother
Du, Chen, Favipiravir: Pharmacokinetics and Concerns About Clinical Trials for 2019-nCoV Infection
Du, Chen, Response to 'Dose Rationale for Favipiravir Use in Patients Infected With SARS-CoV-2
Eloy, Solas, Touret, Dose Rationale for Favipiravir Use in Patients Infected With SARS-CoV-2
Fajnzylber, Regan, Coxen, SARS-CoV-2 viral load is associated with increased disease severity and mortality, Nature Communications
Goyal, Cardozo-Ojeda, Schiffer, Potency and timing of antiviral therapy as determinants of duration of SARS CoV-2 shedding and intensity of inflammatory response, medRxiv
Harris, Taylor, Minor, The REDCap consortium: Building an international community of software platform partners, Journal of Biomedical Informatics
Harris, Taylor, Thielke, Payne, Gonzalez et al., Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support, Journal of Biomedical Informatics
Hassanipour, Arab-Zozani, Amani, Heidarzad, Fathalipour et al., The efficacy and safety of Favipiravir in treatment of COVID-19: a systematic review and meta-analysis of clinical trials, Sci Rep
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, The Lancet
Ison, Scheetz, Understanding the pharmacokinetics of Favipiravir: Implications for treatment of influenza and COVID-19, EBioMedicine
Ivashchenko, Dmitriev, Vostokova, AVIFAVIR for Treatment of Patients with Moderate COVID-19: Interim Results of a Phase II/III Multicenter Randomized Clinical Trial, Clinical
Joshi, Parkar, Ansari, Role of favipiravir in the treatment of COVID-19, Int J Infect Dis
Lou, Liu, Yao, Clinical Outcomes and Plasma Concentrations of Baloxavir Marboxil and Favipiravir in COVID-19 Patients: An Exploratory Randomized, Controlled Trial, European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences
Manabe, Kambayashi, Akatsu, Kudo, Favipiravir for the treatment of patients with COVID-19: a systematic review and meta-analysis, BMC Infect Dis
Moh, for data and insights on COVID-19
Naing, Statistics Resources by Lin Naing
Pilkington, Pepperrell, Hill, A review of the safety of favipiravir -a potential treatment in the COVID-19 pandemic?, Journal of Virus Eradication
Pilkington, Pepperrell, Hill, A review of the safety of favipiravir -a potential treatment in the COVID-19 pandemic?, Journal of virus eradication
Saber-Ayad, Saleh, Abu-Gharbieh, The Rationale for Potential Pharmacotherapy of COVID-19, Pharmaceuticals
Seneviratne, Abeysuriya, Mel, Zoysa, Niloofa, Favipiravir in Covid-19
Shrestha, Budhathoki, Khadka, Shah, Pokharel et al., Favipiravir versus other antiviral or standard of care for COVID-19 treatment: a rapid systematic review and meta-analysis, Virology journal
Sim, Chidambaram, Wong, Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study, The Lancet Regional Health -Western Pacific
Sohrabi, Alsafi, Neill, World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19), Int J Surg
Udwadia, Singh, Barkate, Efficacy and Safety of Favipiravir, an Oral RNA-Dependent RNA Polymerase Inhibitor, in Mild-to-Moderate COVID-19: A Randomized, Comparative, Open-Label, Multicenter, Phase 3 Clinical Trial, International Journal of Infectious Diseases
Yu, Feng, Uyeki, Risk factors for severe illness with 2009 pandemic influenza A (H1N1) virus infection in China, Clin Infect Dis
{ 'indexed': { 'date-parts': [[2021, 11, 19]],
'date-time': '2021-11-19T15:13:55Z',
'timestamp': 1637334835798},
'reference-count': 0,
'publisher': 'Oxford University Press (OUP)',
'content-domain': {'domain': [], 'crossmark-restriction': False},
'short-container-title': ['Clinical Infectious Diseases'],
'DOI': '10.1093/cid/ciab962',
'type': 'journal-article',
'created': { 'date-parts': [[2021, 11, 16]],
'date-time': '2021-11-16T20:12:23Z',
'timestamp': 1637093543000},
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': ['OUP accepted manuscript'],
'prefix': '10.1093',
'member': '286',
'published-online': {'date-parts': [[2021]]},
'container-title': ['Clinical Infectious Diseases'],
'original-title': [],
'deposited': { 'date-parts': [[2021, 11, 18]],
'date-time': '2021-11-18T20:14:44Z',
'timestamp': 1637266484000},
'score': 1,
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021]]},
'references-count': 0,
'URL': 'http://dx.doi.org/10.1093/cid/ciab962',
'relation': {},
'ISSN': ['1058-4838', '1537-6591'],
'issn-type': [{'value': '1058-4838', 'type': 'print'}, {'value': '1537-6591', 'type': 'electronic'}],
'subject': ['Infectious Diseases', 'Microbiology (medical)'],
'published': {'date-parts': [[2021]]}}