Oral favipiravir for patients with delayed SARS-CoV-2 viral RNA clearance: a case series
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RESEARCH LETTER
Open Access
Oral favipiravir for patients with delayed SARS-CoV-2 viral RNA clearance: a case series Dian Fu1,2†, Ruiyuan Cao3†, Lei Zhao3†, Wei Li3†, Wu Zhong3* and Jiqiu Wen1,2*
Keywords: Favipiravir, SARS-CoV-2, COVID-19, viral RNA persistence Dear Editor, The COVID-19 pandemic has caused 14,893,706 infections and 613,879 deaths in 188 countries worldwide as of July 22, 2020, posing the largest world health crisis [1]. Although the pandemic is well controlled in China and the incidence is currently very low, we have observed a number of patients with delayed SARS-CoV-2 viral RNA clearance in the upper respiratory tract (more than 30 days), which combined with asymptomatic carriers, limits the prospect of eliminating the disease. The emergence of patients with delayed viral RNA clearance and healthy viral carriers is a major concern, not only in terms of disease control, but also due to the possible long-term damage to the patients’ health. Previously, we have reported that favipiravir, a broad-spectrum antiviral drug approved in Japan and China, potently inhibits SARS-CoV-2 with a 50% effective concentration (EC50) of 61.88 μM in vitro, indicating its antiviral potential [2]. Notably, favipiravir significantly reduced the time to viral clearance in an open-label nonrandomized controlled trial [3]. Here, we report a series of patients with considerably delayed SARS-CoV-2 RNA clearance and the treatment efficacy of favipiravir in this population. * Correspondence: [email protected]; [email protected] † Dian Fu, Ruiyuan Cao, Lei Zhao and Wei Li contributed equally to this work. 3 National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China 1 National Clinical and Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China Full list of author information is available at the end of the article
From March 26, 2020, we administered oral favipiravir (two doses of 1600 mg on day 1 and 600 mg twice per day on days 2–10 or until SARS-CoV-2 RNA negative) to nine asymptomatic rehabilitation patients. Eight patients were analyzed, and one patient was lost to follow-up due to transfer to another hospital. Of the eight patients included in this analysis, one received the full 10-day course of favipiravir, and seven received 4 to 9 days of favipiravir treatment. The demographic and clinical characteristics of the eight patients are shown in Table 1. The median duration of positive detection of SARS-CoV-2 viral RNA in patients before the initiation of favipiravir treatment was 61.0 days (interquartile range, 52.8 to 67.3 days). Coexisting conditions included hypertension (four patients), diabetes (two patients), coronary heart disease (one patient), and malignant tumor (two patients). No interruption of treatment occurred due to adverse reactions. Over the 14-day follow-up period, the median duration of viral shedding was 3 days (interquartile range, 2 to 6 days) and one patient re
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