TY - JOUR
T1 - Clinical antiviral efficacy of favipiravir in early COVID-19 (PLATCOV)
T2 - an open-label, randomised, controlled, adaptive platform trial
AU - Luvira, Viravarn
AU - Schilling, William H.K.
AU - Jittamala, Podjanee
AU - Watson, James A.
AU - Boyd, Simon
AU - Siripoon, Tanaya
AU - Ngamprasertchai, Thundon
AU - Almeida, Pedro J.
AU - Ekkapongpisit, Maneerat
AU - Cruz, Cintia
AU - Callery, James J.
AU - Singh, Shivani
AU - Tuntipaiboontana, Runch
AU - Kruabkontho, Varaporn
AU - Ngernseng, Thatsanun
AU - Tubprasert, Jaruwan
AU - Abdad, Mohammad Yazid
AU - Keayarsa, Srisuda
AU - Madmanee, Wanassanan
AU - Aguiar, Renato S.
AU - Santos, Franciele M.
AU - Hanboonkunupakarn, Pongtorn
AU - Hanboonkunupakarn, Borimas
AU - Poovorawan, Kittiyod
AU - Imwong, Mallika
AU - Taylor, Walter R.J.
AU - Chotivanich, Vasin
AU - Chotivanich, Kesinee
AU - Pukrittayakamee, Sasithon
AU - Dondorp, Arjen M.
AU - Day, Nicholas P.J.
AU - Teixeira, Mauro M.
AU - Piyaphanee, Watcharapong
AU - Phumratanaprapin, Weerapong
AU - White, Nicholas J.
N1 - Publisher Copyright:
© 2024, The Author(s).
PY - 2024/12
Y1 - 2024/12
N2 - Brief summary: In early symptomatic COVID-19 treatment, high dose oral favipiravir did not accelerate viral clearance. Background: Favipiravir, an anti-influenza drug, has in vitro antiviral activity against SARS-CoV-2. Clinical trial evidence to date is inconclusive. Favipiravir has been recommended for the treatment of COVID-19 in some countries. Methods: In a multicentre open-label, randomised, controlled, adaptive platform trial, low-risk adult patients with early symptomatic COVID-19 were randomised to one of ten treatment arms including high dose oral favipiravir (3.6g on day 0 followed by 1.6g daily to complete 7 days treatment) or no study drug. The primary outcome was the rate of viral clearance (derived under a linear mixed-effects model from the daily log10 viral densities in standardised duplicate oropharyngeal swab eluates taken daily over 8 days [18 swabs per patient]), assessed in a modified intention-to-treat population (mITT). The safety population included all patients who received at least one dose of the allocated intervention. This ongoing adaptive platform trial was registered at ClinicalTrials.gov (NCT05041907) on 13/09/2021. Results: In the final analysis, the mITT population contained data from 114 patients randomised to favipiravir and 126 patients randomised concurrently to no study drug. Under the linear mixed-effects model fitted to all oropharyngeal viral density estimates in the first 8 days from randomisation (4,318 swabs), there was no difference in the rate of viral clearance between patients given favipiravir and patients receiving no study drug; a -1% (95% credible interval: -14 to 14%) difference. High dose favipiravir was well-tolerated. Interpretation: Favipiravir does not accelerate viral clearance in early symptomatic COVID-19. The viral clearance rate estimated from quantitative measurements of oropharyngeal eluate viral densities assesses the antiviral efficacy of drugs in vivo with comparatively few studied patients.
AB - Brief summary: In early symptomatic COVID-19 treatment, high dose oral favipiravir did not accelerate viral clearance. Background: Favipiravir, an anti-influenza drug, has in vitro antiviral activity against SARS-CoV-2. Clinical trial evidence to date is inconclusive. Favipiravir has been recommended for the treatment of COVID-19 in some countries. Methods: In a multicentre open-label, randomised, controlled, adaptive platform trial, low-risk adult patients with early symptomatic COVID-19 were randomised to one of ten treatment arms including high dose oral favipiravir (3.6g on day 0 followed by 1.6g daily to complete 7 days treatment) or no study drug. The primary outcome was the rate of viral clearance (derived under a linear mixed-effects model from the daily log10 viral densities in standardised duplicate oropharyngeal swab eluates taken daily over 8 days [18 swabs per patient]), assessed in a modified intention-to-treat population (mITT). The safety population included all patients who received at least one dose of the allocated intervention. This ongoing adaptive platform trial was registered at ClinicalTrials.gov (NCT05041907) on 13/09/2021. Results: In the final analysis, the mITT population contained data from 114 patients randomised to favipiravir and 126 patients randomised concurrently to no study drug. Under the linear mixed-effects model fitted to all oropharyngeal viral density estimates in the first 8 days from randomisation (4,318 swabs), there was no difference in the rate of viral clearance between patients given favipiravir and patients receiving no study drug; a -1% (95% credible interval: -14 to 14%) difference. High dose favipiravir was well-tolerated. Interpretation: Favipiravir does not accelerate viral clearance in early symptomatic COVID-19. The viral clearance rate estimated from quantitative measurements of oropharyngeal eluate viral densities assesses the antiviral efficacy of drugs in vivo with comparatively few studied patients.
KW - Antiviral efficacy
KW - COVID-19
KW - Early treatment
KW - Favipiravir
KW - Pharmacometrics
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85182498551&partnerID=8YFLogxK
U2 - 10.1186/s12879-023-08835-3
DO - 10.1186/s12879-023-08835-3
M3 - Article
C2 - 38225598
AN - SCOPUS:85182498551
SN - 1471-2334
VL - 24
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 89
ER -
