Murat KIYIK,
Sedat ALTIN,
Kürşad Nuri BAYDİLİ,
Filiz KOŞAR,
Elif TANRIVERDİ,
Erdoğan ÇETİNKAYA,
Halit ÇINARKA,
Sibel YURT,
Gülşah GÜNLÜOĞLU,
Mustafa ÇÖRTÜK,
Melih Akay ARSLAN,
Aysu Sinem KOÇ
6426
The comparison of favipiravir and lopinavir/ritonavir combination in COVID-19 treatment
The comparison of favipiravir and lopinavir/ritonavir combination in COVID-19 treatment
Background/aim: SARS-CoV-2, a ribonucleic acid coronavirus, rapidly spread worldwide within a short timeframe. Although different antiviral, antiinflammatory, and immunomodulatory drugs are used, current evidence is insufficient as to which drug is more efficient. Our study compared favipiravir and lopinavir/ritonavir (LPV/RTV) therapies in inpatient care for coronavirus disease 2019 (COVID-19) pneumonia. Materials and methods: Demographic data, test results, treatments, and latest status of patients receiving inpatient COVID-19 pneumonia therapy were recorded. The initial favipiravir and LPV/RTV receiving groups were compared regarding the need for intensive care units (ICU) and mortality. Logistic regression analysis was performed by including variables showing significant differences as a result of paired comparisons into the model. Results: Of the 204 patients with COVID-19 pneumonia, 59 (28.9%), 131 (64.2%), and 14 were administered LPV/RTV, favipiravir, and favipiravir with LPV/RTV, respectively. No difference was found in age, sex, presence of comorbidity, and tocilizumab, systemic corticosteroid, and plasma therapy use between patients administered with these three different treatment regimens. The mean mortality age of the patients was 71 ± 14.3 years, which was substantially greater than that of the survivors (54.2 ± 15.5 years). Compared with patients administered with LPV/RTV, ICU admission and mortality rates were lower in patients administered with favipiravir. CK-MB, AST, CRP, LDH, and creatinine levels were higher, whereas lymphocyte counts were lower in patients who died. Age, AST, CRP, LDH, and neutrophil counts were higher in patients needing ICU, and eosinophil and lymphocyte counts were significantly lower. Logistic regression analysis showed that favipiravir use independently decreased mortality (p = 0.006). Conclusion: The use of favipiravir was more effective than LPV/RTV in reducing mortality in hospitalized patients with COVID-19.Key words: COVID-19, pneumonia, favipravir, lopinavir/ritonavir, mortality
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- 1. Elsawah HK, Elsokary MA, Abdallah MS, ElShafie AH. Efficacy and safety of remdesivir in hospitalized Covid-19 patients: systematic review and meta-analysis including network meta-analysis. Reviews in Medical Virology 2020: e2187. doi: 10.1002/rmv.2187
- 2. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R et al. COVID-19 diagnosis and management: a comprehensive review. Journal of Internal Medicine 2020; 288 (2): 192-206. doi: 10.1111/joim.13091
- 3. Lu CC, Chen MY, Lee WS, Chang YL. Potential therapeutic agents against COVID-19: what we know so far. Journal of The Chinese Medical Association 2020; 83 (6): 534-536. doi: 10.1097/JCMA.0000000000000318
- 4. Cao B, Wang Y, Wen D, Liu W, Wang J et al. A trial of lopinavirritonavir in adults hospitalized with severe Covid-19. The New England Journal of Medicine 2020; 382 (19): 1787-1799. doi: 10.1056/NEJMoa2001282
- 5. Deng L, Li C, Zeng Q, Liu X, Li X et al. Arbidol combined with LPV/r versus LPV/r alone against Corona virus disease 2019: a retrospective cohort study. Journal of Infection 2020; 81 (1): 1-5. doi: 10.1016/j.jinf.2020.03.002
- 6. Hung IF, Lung KC, Tso EY, Liu R, Chung TW et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet 2020; 395: 1695-1704. doi: 10.1016/S0140-6736(20)31042-4
- 7. Cai Q, Yang M, Liu D, Chen J, Shu D et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering (Beijing) 2020; 6 (10): 1192-1198. doi: 10.1016/j.eng.2020.03.007
- 8. Chen C, Zhang Y, Huang J, Yin P, Cheng Z et al. Favipiravir versus arbidol for COVID-19: a randomized clinical trial. bioRxiv (preprint). https://doi.org/10.1101/2020.03.17.20037432
- 9. Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D et al. COVID-19 and older adults: what we know. Journal of The American Geriatrics Society 2020; 68(5): 926-929. doi: 10.1111/jgs.16472
- 10. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
- 11. Li L, Zhang B, He B, Gong Z, Chen X. Critical patients with coronavirus disease 2019: risk factors and outcome nomogram. Journal of Infection 2020; 80 (6): 37-38. doi: 10.1016/j. jinf.2020.03.025