Assessment of outcomes following implementation of antiviral treatment guidelines for COVID-19 during the first wave in Thailand

Sawanpanyalert et al., Southeast Asian Journal of Tropical Medicine and Public Health, 52:4, Sep 2021

HCQ for COVID-19

1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 424 studies, used in 59 countries.

Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments.

6,200+ studies for 200+ treatments. c19early.org

Download Meta Analysis

Retrospective 744 hospitalized patients in Thailand, showing lower risk of a poor outcome for favipiravir treatment within 4 days of symptom onset. Early treatment with CQ/HCQ and lopinavir/ritonavir or darunavir/ritonavir also showed lower risk, but without statistical significance. Sample sizes for the number of patients treated within 4 days of symptom onset are not provided.

Important missing comments or errors? Let us know.

Study covers favipiravir and HCQ.

risk of death, ICU, intubation, or high-flow oxygen, 42.0% lower, OR 0.58, p = 0.37, within 4 days of symptom onset, RR approximated with OR.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Sawanpanyalert et al., 9 Sep 2021, retrospective, Thailand, peer-reviewed, 11 authors, dosage varies, this trial uses multiple treatments in the treatment arm (combined with lopinavir/ritonavir or darunavir/ritonavir) - results of individual treatments may vary.

ASSESSEMENT OF OUTCOMES FOLLOWING IMPLEMENTATION OF ANTIVIRAL TREATMENT GUIDELINES FOR COVID-19 DURING THE FIRST WAVE IN THAILAND

Narumol Sawanpanyalert, Rujipas Sirijatuphat, Piamlarp Sangsayunh, Opass Putcharoen, Weerawat Manosuthi, Poj Intalapaporn, Nattawan Palavutitotai, Worawan Samritmanoporn, Nattapong Jitrungruengnij, Alan Maleesatharn

Thailand encountered its first coronavirus disease 2019 outbreak in March 2020 and the Thailand Ministry of Public Health rapidly developed COVID-19 treatment guidelines. In this study we aimed to describe the outcomes among patients treated following those initial guidelines and determine factors significantly associated with poor outcomes in order to inform efforts to improve COVID-19 treatment guidelines for Thailand. Nine hospitals in Bangkok submitted data from their COVID-19 patients using standardized case record forms. A poor outcome was defined as death, ICU admission, requiring intubation or requiring high-flow oxygen. Factors associated with these outcomes were assessed. A total of 744 patients (48.8% male) were included in the study. The median (interquartile range) age of study subjects was 37 (27-48) years; 8.4% were aged >60 years, 5.6% of subjects were obese and 16.5% had underlying conditions: obesity, immunocompromised status, diabetes, chronic conditions of lungs, kidneys, liver, cardiovascular or cerebrovascular systems or had an absolute lymphocyte count <1,000 cells/mm 3 . Among symptomatic patients, factors significantly independently associated with a poor outcome were: age >60 years (adjusted odds ratio (

References

Cai, Yanga, Liu, Experimental t r e a t m e n t w i t h f a v i p i r a v i r f o r COVID-19: an open-label control study, Engineering

Cao, Wang, Wen, A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19, N Engl J Med

Cavalcanti, Zampieri, Rosa, Hydroxychloroquine with or without azithromycin in mild-tomoderate COVID-19, N Engl J Med

Chen, Zhang, Huang, Favipiravir versus arbidol for COVID-19: a randomized clinical trial, doi:10.1101/2020.03.17.20037432v4.full.pdf+html

Chu, Cheng, Hung, Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings, Thorax

Doi, Hibino, Hase, A prospective, randomized, open-label trial of early versus late favipiravir therapy in hospitalized patients with COVID-19, Antimicrob Agents Chemother

Fujifilm Toyama, Co L T D, AV I G A N Ta b l e t s 2 0 0 m g : Prescribing information

Hassanipour, Arab-Zozani, Amani, H E I D A R Z A D F , F A T H A L I P O U R, Martinez-De-Hoyo, The efficacy and safety of favipiravir in treatment of COVID-19: a systematic review and meta-analysis of clinical trials, Sci Rep

Hu, Wang, The clinical characteristics and risk factors of severe COVID-19, Gerontology

Ivashchenko, Dmitriev, Vostokova, AVIFAVIR for treatment of patients with moderate COVID-19: interim results of a Phase II/III multicenter randomized clinical trial, Clin Infect Dis

Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov

Manosuthi, Jeungsmarn, Okada, Nasopharyngeal SARS-CoV-2 viral load response among COVID-19 patients receiving favipiravir, N Engl J Med

Recovery Collaborative, Lopinavir-ritonavir in patients admitted to hospital with COVID-19 ( R E C O V E R Y ) : a r a n d o m i s e d , controlled, open-label, platform trial, N Engl J Med

Rosenberg, Dufort, Udo, A s s o c i a t i o n o f t r e a t m e n t w i t h hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State, JAMA

Sim, Chidambaram, Wong, Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: a nationwide observational study, Lancet Reg Health West Pac

Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res

Weiss, Jellingsø, Sommera, Spatial and temporal dynamics of SARS-CoV-2 in COVID-19 patients: a systematic review and meta-analysis, EBioMedicine

Wolff, Nee, Hickey, Marschollek, Risk factors for COVID-19 severity and fatality: a structured literature review, Infection