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Multicenter Study
. 2023 Sep;16(9):1492-1499.
doi: 10.1016/j.jiph.2023.06.011. Epub 2023 Jun 14.

When antivirals backfire: An evaluation of favipiravir's clinical outcomes in critically ill patients with COVID-19: A multicenter cohort study

Khalid Al Sulaiman  1 , Ohoud Aljuhani  2 , Ghazwa B Korayem  2 , Ali F Altebainawi  3 , Mashael AlFaifi  4 , Majed Nahari  5 , Alaa Almagthali  6 , Abrar K Thabit  7 , Raghad Alhajaji  8 , Reham Alharbi  9 , Khawla Kahtani  10 , Abeer A Alenazi  11 , Aisha Alharbi  12 , Munirah M Alghwainm  13 , Sara M Alotaibi  14 , Yazeed S Alghamdi  14 , Samar Alotaibi  15 , Shaden H Alonazi  14 , Jumanah M Almutairi  14 , Ramesh Vishwakarma  16
Affiliations
Multicenter Study

When antivirals backfire: An evaluation of favipiravir's clinical outcomes in critically ill patients with COVID-19: A multicenter cohort study

Khalid Al Sulaiman et al. J Infect Public Health. 2023 Sep.

Abstract

Background: Favipiravir is an oral antiviral, that might treat COVID-19 by enhancing viral eradication, particularly in patients with mild-to-moderate disease. Yet, the findings on the use of favipiravir in critically ill patients with COVID-19 are inconsistent. Therefore, this study aimed to assess the effectiveness and safety of favipiravir in critically ill patients with COVID-19.

Method: A multicenter retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care units (ICUs) was conducted from March 2020 to July 2021. Patients were categorized based on favipiravir use (control vs. favipiravir). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation (MV) duration, 30-day mortality, ICU length of stay (LOS), hospital LOS, and complications during the stay.

Results: After propensity score (PS) matching (1:1 ratio), 146 patients were included in the final analysis. A higher in-hospital and 30-day mortality were observed in patients receiving favipiravir compared to the control group at crude analysis (65.3% vs. 43.8%; P-value=0.009 and 56.3% vs. 40.3; P-value=0.06, respectively); however, no differences were observed using multivariable Cox proportional hazards regression analysis (HR 1.17; 95% CI 0.73, 1.87; P-value =0.51 and HR 0.86; 95% CI 0.53, 1.39; P-value=0.53, respectively). Conversely, the MV duration and ICU LOS were longer in patients who received favipiravir than the control group (β coefficient 0.51; CI 0.09, 0.92; P-value = 0.02, β coefficient 0.41; CI 0.17, 0.64; P-value = 0.0006, respectively). Complications during the stay were comparable between the two groups.

Conclusion: The use of favipiravir in critically ill patients with COVID-19 did not demonstrate a reduction in mortality; instead, it was linked with longer MV duration and ICU stay. This finding suggests limiting favipiravir use to infections where it is more effective, other than COVID-19. Further randomized clinical trials are needed to confirm these findings.

Keywords: Critically ill; Favipiravir; Intensive care units; MV duration, Length of stay (LOS), COVID-19; Mortality; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest We have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Flow diagram showing patients recruited with COVID-19.
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