key: cord-0733963-2dmtgstl
authors: Dauby, Nicolas
title: Favipiravir as an antiviral agent in COVID-19: same script, different cast?
date: 2020-10-19
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1600
sha: 46d942f46834b9c76a11fd4b534acc3530525291
doc_id: 733963
cord_uid: 2dmtgstl

nan

A c c e p t e d M a n u s c r i p t infection and in a model of reconstituted human airway epithelium [5] . Moreover, a unpublished large RCT using high doses of HCQ has not demonstrated any benefit of HCQ therapy in patients with advanced COVID-19 [6] .

Before promoting the use of FVP in COVID-19 it is thus important to take into consideration the available evidence regarding anti-viral activity both in vitro and in animal studies, pharmacokinetics studies in COVID-19 and more importantly clinical benefit.

In vitro activity of FVP is lower as compared to remdesivir (RDV) [2] . Importantly, RDV has failed to show any positive impact on viral excretion and mortality in a RCT [7] . Studies by two different groups using hamster model of SARS-CoV-2 infection have shown that the antiviral effect of FVP is A c c e p t e d M a n u s c r i p t modest. Antiviral effect has been shown to be dose-dependent and effective doses were associated with higher toxicity [8, 9] .

Importantly, based on the experience acquired in a trial using FVP in Ebola virus infection, it has been estimated that the doses used by Ivashchenko et al. are unlikely to achieve target drug concentrations against SARS-CoV-2 [10] . Accordingly, FVP concentrations have been found to be lower than the lower limit of quantification in critically ill patients with COVID-19 receiving similar drug dosage than used in the trial published by Ivashchenko et al. [11] The fact that FVP is an orally available drug with favorable safety profile [12] makes it an ideal option as anti-viral agent for COVID-19. However, we should not repeat the same script we wrote with HCQ. The use of FVP in COVID-19 should only be promoted following demonstration of a relevant clinical benefit such as mortality or intensive care unit transfer.

The author has no potential conflicts of interest.

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Antiviral treatment of SARS-CoV-2-infected hamsters reveals a weak effect of favipiravir and a complete lack of effect for hydroxychloroquine

Favipiravir antiviral efficacy against SARS-CoV-2 in a hamster model

Dose Rationale for Favipiravir Use in Patients Infected With SARS-CoV-2

Pharmacokinetics of Favipiravir in Critically Ill Patients With COVID-19

A review of the safety of favipiravir -a potential treatment in the COVID-19 pandemic?

A c c e p t e d M a n u s c r i p t