The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Abstract
Objectives: Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There
is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2.
This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with
COVID-19.
Methods: Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT–PCR or bilateral multi-lobar
ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into
two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants
also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and
single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge
from hospital with secondary endpoints of duration of ICU stay and mortality.
Results: Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27
in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days
for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for
the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95%
CI 0.04–0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1–12.1, P < 0.01).
Conclusions: Given these encouraging initial results, and the current lack of treatments proven to decrease
mortality in COVID-19, further investigation in larger-scale trials seems warranted.
Description
Keywords
antiviral agent, sintensive care unit, patient discharge, ribavirin, arm, mortality, daclatasvir, sofosbuvir, sars-cov-2, covid-19
Citation
Eslami, G., Mousaviasl, S., Radmanesh, E., Jelvay, S., Bitaraf, S., Simmons, B., Wentzel, H., Hill, A., Sadeghi, A., Freeman, J., Salmanzadeh, S., Esmaeilian, H., Mobarak, M., Tabibi, R., Jafari Kashi, A. H., Lotfi, Z., Talebzadeh, S. M., Wickramatillake, A., Momtazan, M., … Mobarak, S. (2020). The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19. Journal of Antimicrobial Chemotherapy, 75(11), 3366–3372. https://doi.org/10.1093/jac/dkaa331