1. When antivirals backfire: An evaluation of favipiravir’s clinical outcomes in critically ill patients with COVID-19: A multicenter cohort study
- Author
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Khalid Al Sulaiman, Ohoud Aljuhani, Ghazwa B. Korayem, Ali F. Altebainawi, Mashael AlFaifi, Majed Nahari, Alaa Almagthali, Abrar K. Thabit, Raghad Alhajaji, Reham Alharbi, Khawla Kahtani, Abeer A. Alenazi, Aisha Alharbi, Munirah M. Alghwainm, Sara M. Alotaibi, Yazeed S. Alghamdi, Samar Alotaibi, Shaden H. Alonazi, Jumanah M. Almutairi, and Ramesh Vishwakarma
- Subjects
Favipiravir ,Mortality ,MV duration, Length of stay (LOS), COVID-19 ,SARS-CoV-2 ,Intensive care units ,Critically ill ,Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - 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.
- Published
- 2023
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