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Efficacy and safety of favipiravir plus interferon-beta versus lopinavir/ritonavir plus interferon-beta in moderately ill patients with COVID-19: A randomized clinical trial

Hassaniazad et al., Journal of Medical Virology, doi:10.1002/jmv.27724, IRCT20200506047323N3
Mar 2022  
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Mortality, day 14 68% Improvement Relative Risk Mortality, day 7 3% ICU admission 35% Hospitalization time 25% Viral clearance 18% Favipiravir  Hassaniazad et al.  LATE TREATMENT  RCT Is late treatment with favipiravir beneficial for COVID-19? RCT 63 patients in Iran Trial compares with lopinavir/ritonavir, results vs. placebo may differ Lower mortality (p=0.15) and ICU admission (p=0.51), not sig. c19early.org Hassaniazad et al., J. Medical Virology, Mar 2022 Favorsfavipiravir Favorslopinavir/ri.. 0 0.5 1 1.5 2+
RCT comparing favipiravir and lopinavir/ritonavir, showing no significant differences. All patients received interferon-beta. Favipiravir 1600mg bid for the first day and 600mg bid for the following 4 days.
Potential risks of favipiravir include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity1-5.
risk of death, 67.7% lower, RR 0.32, p = 0.15, treatment 2 of 32 (6.2%), control 6 of 31 (19.4%), NNT 7.6, day 14.
risk of death, 3.1% lower, RR 0.97, p = 1.00, treatment 1 of 32 (3.1%), control 1 of 31 (3.2%), NNT 992, day 7.
risk of ICU admission, 35.4% lower, RR 0.65, p = 0.51, treatment 4 of 32 (12.5%), control 6 of 31 (19.4%), NNT 15, day 14.
hospitalization time, 25.0% lower, relative time 0.75, p = 0.14, treatment 32, control 31.
risk of no viral clearance, 18.0% lower, RR 0.82, p = 0.24, treatment 22 of 32 (68.8%), control 26 of 31 (83.9%), NNT 6.6, day 7.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Hassaniazad et al., 24 Mar 2022, Randomized Controlled Trial, Iran, peer-reviewed, mean age 53.8, 7 authors, this trial compares with another treatment - results may be better when compared to placebo, trial IRCT20200506047323N3. Contact: m.fathalipour@yahoo.com.
This PaperFavipiravirAll
Efficacy and safety of favipiravir plus interferon‐beta versus lopinavir/ritonavir plus interferon‐beta in moderately ill patients with COVID‐19: A randomized clinical trial
Mehdi Hassaniazad, Hossein Farshidi, Abdollah Gharibzadeh, Ali Bazram, Elham Khalili, Afsaneh Noormandi, Mohammad Fathalipour
Journal of Medical Virology, doi:10.1002/jmv.27724
Favipiravir (FVP), lopinavir/ritonavir (LPV/RTV), and interferon-beta (INF-beta) are considered as potential treatments for COVID-19. We examined the efficacy and safety of FVP and INF-beta compared to LPV/RTV and INF-beta combinations for the treatment of SARS-CoV-2. It was a single-center randomized clinical trial. Eligible patients were randomized to receive FVP plus INF-beta versus LPV/RTV plus INF-beta. The primary endpoint was the viral clearance after seven days of randomization. ICU admission, length of stay (LOS) in hospital, in-hospital mortality, and the incidence of adverse events were also measured. This trial was registered on the Iranian Registry of Clinical Trials (IRCT20200506047323N3). Patients were randomly allocated to the FVP (n = 33) and LPV/RTV (n = 33) groups. The viral clearance on Day seven was not significantly different between the FVP (31.1%) and the LPV/RTV groups (16.1%). The rate of ICU admission and likewise the in-hospital mortality in the FVP group (12.5% and 6.3%, respectively) were similar to the LPV/RTV groups (19.4% and 19.4%, respectively). The median LOS in the hospital was also not different (6.8 days [interquartile range; IQR = 5.0-11.0] in the FVP and (8.0 days [IQR = 5.5-12.5]) in LPV/RTV groups (p = 0.140). Adverse events were observed in 25.0% of FVP and 32.3% of LPV/RTV groups. The combination therapy with FVP did not exert a higher efficacy compared to the combination regimen of LPV/RTV. However, both treatment regimens demonstrated a mild profile of adverse events.
ACKNOWLEDGMENTS The authors appreciably thank the trial patients and their families, whose help and participation made this study possible. This study was financially supported by Hormozgan University of Medical Sciences (Grant no: 990233). CONFLICTS OF INTEREST The authors declare no conflicts of interest. SUPPORTING INFORMATION Additional supporting information may be found in the online version of the article at the publisher's website.
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Late treatment
is less effective
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