A Review of Remdesivir and Favipiravir for the Treatment of Coronavirus Disease 19 (Covid-19)

Date of Award

5-2022

Document Type

Thesis

Degree Name

Master of Science in Biology

First Advisor

Arni E. Gambe-Gilbuena, PhD

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has been responsible for millions of deaths worldwide and has forced countries around the world to halt movement of both people and goods. While vaccines are the best option to end the spread of COVID-19, their distribution may take time to reach more depressed areas of the world. Treatments are still needed as well for the people already infected and the people who will be affected with COVID-19. Furthermore, the emergence of variants in SARS-CoV-2 indicates there is an ongoing need to search for therapeutics in order to mitigate the variants. This systematic review will scrutinize two repurposed drugs that are similar in function, remdesivir and favipiravir, considered to be candidates as anti-SARS-CoV- 2 drugs based on clinical trials. The main aim of this systematic review is to assess the efficacy of the two drugs through several metrics including mortality rate, Day 7 recovery rate, Day 14 recovery rate, Day 28 recovery rate, and median time to recovery. A search, conducted from July 2020 until May 2021, was carried out in four databases, namely; PubMed, MedRxiv, ScienceDirect and ClinicalTrials.gov. A total of 4 studies for remdesivir and 6 studies for favipiravir met the review criteria and were eligible for review; all studies selected are randomized clinical trials. Based on acquired clinical trials and statistical analysis of these studies, remdesivir was considered to have efficacy against SARS-CoV-2 based on Day 14 (OR: 1.45, 95CI:1.21, 1.75. p< 0.05) and Day 28 recovery rates (OR:1.41, 95CI: 1.14, 1.74. p< 0.05). However, mortality (RR: 0.92, 95CI: 0.76, 1.11. p=0.60), Day 7 recovery rate (OR: 1.15, 95CI: 0.77, 1.71. p=0.30), and time to recovery (p=0.743) were not considered to be statistically significant for remdesivir. Favipiravir did not show statistically significant efficacy against SARS-CoV-2 in terms of mortality (RR: 1.10, 95CI: 0.66, 1.84. p=0.83) nor in recovery rates on days 7 (OR: 1.41, 95CI: 0.86, 2.32. p=0.52) and 14 (OR: 0.81, 95CI: 0.23, 2.93. p=0.19). While not statistically significant (p=0.733), favipiravir shows promise in reducing recovery time but more research needs to be conducted. The results in this work support the policies of governments that approve of remdesivir with emergency use authorization. The results are also in agreement with the observation that remdesivir is effective if administered in specific situations such as early hospitalization of moderate to severe COVID-19 patients. Although the results do not support the continued use of favipiravir, the need for more clinical trials to further investigate the clinical recovery time has been highlighted.

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