Background. Favipiravir is a broad−spectrum oral antiviral agent that shows in vitro activity against SARS−CoV−2. Presently, data on the effectiveness and optimal dosage of favipiravir for treating COVID−19 is limited. Methods. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Results. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these, 27.0% required an O2−nasal cannula, 9.5% required non−invasive ventilation and/or high−flow O2−therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5(0−16). The Day−7 clinical improvement rate [95%CI] was 66.7%[53.7−78.0%] in all patients, 92.5%[75.7%−99.1%] in patients who did not require O2−supplementation, and 47.2%[0.4%−64.5%] in patients who required O2−supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. Multivariate analysis revealed three poor prognostic factors for Day−7 clinical improvement [odds ratio (95%CI); p−value]: older age [0.94 (0.89 to 0.99); p=0.04], higher baseline NEWS2 score [0.64 (0.47 to 0.88); p=0.006], and lower favipiravir loading dose (≤45 mg/kg/day) [0.04 (0.005 to 0.4); p=0.006]. Conclusions. Our study reports the promising effectiveness of favipiravir for treating COVID−19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≥45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.

Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O2 nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O2 therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O2 supplementation, and 47.2% [0.4–64.5%] in patients who required O2 supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.