Observational study of the effects of Favipiravir vs Lopinavir/Ritonavir on clinical outcomes in critically Ill patients with COVID‐19

Abstract

What is known and objectives In November 2019, several patients were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in Wuhan, China. So far, there are no specific treatments with proven high efficacy in patients with SARS‐CoV‐2. Presently, several drugs, such as hydroxychloroquine, ribavirin, favipiravir (FVP), lopinavir/ritonavir (LPV/r), remdesivir and oseltamivir, have been suggested as effective treatments for SARS‐CoV‐2. The aim of this study was to describe the clinical experience with FPV and LPV/r in critically ill patients with COVID‐19 at Sakarya University Education and Research Hospital. Methods The study included 107 consecutive patients who had a laboratory confirmation of COVID‐19 and were admitted to the intensive care unit (ICU) between 19 March and 19 May 2020. Follow‐up continued through 30 May 2020 when the last observed patients were discharged. Results and discussion Of the 107 patients, 65 received FPV (Group FPV) and 42 received LPV/r (Group LPV/r). The two groups were similar in terms of demographic data and clinical findings. 43 (66.2%) of the 65 patients in the FPV group and 23 (54.8%) of the 42 patients in the LPV/r group died (p = 0.237). The median ICU stay was 6.6 (IQR, 3–10) days in the FPV group and 9 (IQR, 6–16) days in the LPV/r group, which was a statistically significant difference (p = 0.010). What is new and conclusion The length of hospital stay was significantly lower in the FVP group compared to the LPV/r group among patients who were discharged from the ICU. Although the analysis was done with a limited number of patients and the observed difference in mortality rate is of some concern, FVP treatment may be more beneficial than LPV/r in terms of effective use in the ICU.

Favipiravir versus standard of care in patients with severe COVID-19 infections: A retrospective comparative study

“…In addition, bacteremia was more commonly encountered in patients in the favipiravir group, many of these pathogens are difficult to treat, carry additional risks, and probably represent additional risk for the mortality seen in the favipiravir group. Our data are comparable to the findings reported in two other studies that addressed the outcomes of antiviral treatment of severe COVID-19 infections with favipiravir versus lopinavir/ritonavir; Solaymani-Dodaran et al [ 23 ] reported no significant effect of favipiravir in terms of mortality (26 [13%] versus 17 [11%]), ICU admission, or mechanical ventilation in comparison to lopinavir/ritonavir, while H. Kocayigit et al [ 24 ] reported a high mortality in patients with severe COVID-19 infections who received favipiravir with a mortality rate of 66.2% versus 54.3% in the comparator drug. In another study by F. Khamisa et al [ 25 ] where the use of favipiravir plus inhaled interferon beta-1b was compared to hydroxychloroquine in patients with moderate to severe COVID-19 infection, favipiravir therapy was reported to have no significant advantage in regards to ICU admission (18.2% vs 17.8%; p = 0.960), and overall mortality (11.4% vs 13.3%; p = 0.778).…”

RETRACTED: Antiviral treatment could not provide clinical benefit in management of mild COVID-19: A Retrospective Experience from Field hospital

“…This study revealed that patients with comorbidities tended to have more severe disease which was similar to the previous study [ 15 ]. Prior studies demonstrated better therapeutic response from favipiravir than lopinavir/ritonavir or darunavir/ritonavir in severe [ 16 ] and non-severe groups [ 17 ]. However, we could not demonstrate difference of disease outcome between these two drugs because favipiravir was used in almost all cases (95–100%) according to our national guideline.…”

Antiviral treatment selection for SARS-CoV-2 pneumonia

“…In a Russian adaptive, multicenter, open label, randomized, phase 2/3 clinical trial of FPV versus standard care in hospitalized patients with moderate COVID-19, patients treated with FPV achieved viral clearance (62.5% vs 30% at day 5, 92.5% vs 80% at day 10) and apyrexia faster (median of 2 days vs 4 days) than those receiving standard care only [27]. Conflicting results were provided by other small studies, with some [28][29][30] suggesting a faster achievement of clinical cure in patients receiving FPV and others not [31]. It should be noted that in some studies FPV has been administered in combination with inhaled…”