Consequence of Antivirals Versus Standard Care on Clinical Situation in Patients With COVID-19

Favipiravir and remdesivir have recently received more clinical interest for the management of COVID-19. The study aimed to explore the effectiveness of favipiravir or remdesivir on the clinical outcome of SARS-CoV-2 patients in comparison with standard care. All patients were given standard care before being randomized into the following 3 groups: standard care group (standard care only), remdesivir group (remdesivir and standard care), and favipiravir group (group 3, favipiravir and standard care). The primary endpoint of the study was time to recovery or the clinical condition of patients on day 14. A total of 156 patients underwent randomization (53 assigned to standard care group, 51 to favipiravir group, and 52 to remdesivir group). The percentage of death in favipiravir and remdesivir groups was higher than those in the standard care group and likewise the liver enzymes. Studying the time to starting therapy showed that early administration of antivirals resulted in lower percentage of mortality. The ratio of hazard for early favipiravir and remdesivir was lower in comparison with those treated with late administration of the same drugs (hazard ratio, 0.62; 95% confidence interval [CI], 0.62–0.73 vs 3.22; 95% CI, 3.21–3.44, respectively, for favipiravir and 0.11; 95% CI, 0.10–0.12 vs 3.44; 95% CI, 3.43–3.55, respectively, for remdesivir). For favipiravir or remdesivir to have more beneficial effects than standard care alone for SARS-CoV-2 patients, they need to be started as early as possible. However, regular monitoring of liver function is required.