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HM Rando committed Feb 16, 2021
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Expand Up @@ -143,7 +143,7 @@ The effectiveness of favipiravir for treating patients with COVID-19 is currentl
An open-label, nonrandomized, before-after controlled study was recently conducted [@doi:10.1016/j.eng.2020.03.007].
The study included 80 COVID-19 patients (35 treated with favipiravir, 45 control) from the isolation ward of the National Clinical Research Center for Infectious Diseases (The Third People’s Hospital of Shenzhen), Shenzhen, China.
The patients in the control group were treated with other antivirals, such as lopinavir and ritonavir.
It should be noted that although the control patients received antivirals, two subsequent large-scale analyses, the WHO Solidarity trial and the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, identified no effect of lopinavir or of a lopinavir-ritonavir combination, respectively, on the metrics of COVID-19-related mortality that each assessed [@doi:10.1056/NEJMoa2023184; @doi:10/fnx2; @doi:10.1056/NEJMe2034294].
It should be noted that although the control patients received antivirals, two subsequent large-scale analyses, the WHO Solidarity trial and the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, identified no effect of lopinavir or of a lopinavir-ritonavir combination, respectively, on the metrics of COVID-19-related mortality that each assessed [@doi:10.1056/NEJMoa2023184; @doi:10/fnx2; @doi:10.1056/NEJMe2034294].
Treatment was applied on days 2-14; treatment stopped either when viral clearance was confirmed or at day 14.
The efficacy of the treatment was measured by, first, the time until viral clearance using Kaplan-Meier survival curves, and, second, the improvement rate of chest computed tomography (CT) scans on day 14 after treatment.
The study found that favipiravir increased the speed of recovery, measured as viral clearance from the patient by RT-PCR, with patients receiving favipiravir recovering in four days compared to 11 days for patients receiving antivirals such as lopinavir and ritonavir.
Expand Down Expand Up @@ -661,7 +661,7 @@ Of the 21,550 patients enrolled in the RECOVERY trial at the time, 4,116 adults
Among them, 2,022 were randomized to receive TCZ and 2,094 were randomized to SOC, with 79% of patients in each group available for analysis at the time that the initial report was released.
The primary outcome measured was 28-day mortality, and TCZ was found to reduce 28-day mortality from 33% of patients receiving SOC alone to 29% of those receiving TCZ, corresponding to a rate ratio of 0.86 (95% CI 0.77-0.96; _p_ = 0.007).
TCZ was also significantly associated with the probability of hospital discharge within 28 days for living patients, which was 47% in the SOC group and 54% in the TCZ group ( (rate ratio 1.22, 95% CI 1.12-1.34, _p_ < 0.0001).
A potential association between the TCZ administrtion in combination with a corticosteroid was observed, but the authors note that caution is advisable in light of the number of statistical tests conducted.
A potential association between the TCZ administration in combination with a corticosteroid was observed, but the authors note that caution is advisable in light of the number of statistical tests conducted.
Combining the RECOVERY trial data with data from seven smaller randomized control trials indicates that TCZ is associated with a 13% reduction in 28-day mortality (rate ratio 0.87, 95% CI 0.79-0.96, _p_ = 0·005) [@doi:10.1101/2021.02.11.21249258].
While this initial report did not include the full results expected from the RECOVERY trial, this large-scale, randomized controlled trial therefore offers strong evidence that TCZ may offer benefits for COVID-19 patients, even at this initial stage of analysis.

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