Öz
Amaç: COVID-19 pandemisinde RNA bağımlı bir RNA polimeraz inhibitörü olan favipiravirin erken kullanımına ilişkin olumlu sonuçlar bildirilmiştir. Çalışmamızda favipiravirin erken kullanımı ile geç kullanımı karşılaştırarak COVID-19 pnömonisi ve sepsis kontrolünde favipiravirin potansiyel rolünü anlamayı amaçladık.
Gereç ve Yöntem: Türkiye’de Sağlık Bakanlığı tarafından sürekli güncellenen kılavuzlar doğrultusunda tedaviler yürütülmektedir.14 Nisan 2020 tarihinde yayınlanan rehberin ardından geç dönemde son tedavi seçeneği olarak favipiravir almış 18 hastayı ve erken dönemde almış olan 17 hastayı iki farklı grupta inceledik. Her iki gruptaki hastaların demografik özellikleri, komorbiditeleri, APACHE-II skorları, ardışık SOFA skorları ve mortalite durumları kaydedildi.
Bulgular: Gruplar arası cinsiyet ve yaş farkı istatistiksel olarak anlamlı değildi. Gruplar arası APACHE-II puanı açısından fark istatistiksel olarak anlamlıydı (p=0.018). Geç dönemde kullanan grubun APACHE-II puanları daha yüksekti. Gruplar arasında mortalite oranı favipiraviri erken kullanan grupta istatistiksel olarak anlamlı olmasa da numerik olarak daha düşüktü.
Sonuç: Sınırlı sayıda hasta ile yapılan çalışmalarda, favipiravirin erken dönemde kullanıldığında viral klirenste lopinavir/ritonavire göre belirgin bir avantaj sağladığı ve viral yükte önemli bir azalma sağladığı gösterilmiştir. Favipiraviri geç dönemde kullanan grup bize daha ciddi geldi ve mortalite oranı daha yüksekti. Favipiravir az hasta sayılı çalışmalarda bile anlamlı bir etki yaptığı ve bu konuda yapılacak daha büyük çalışmalara ihtiyaç olduğunu düşünüyoruz.
Anahtar Kelimeler
Kaynakça
- Kalil AC. Treating COVID-19-off-label drug use, compassionate use, and randomized clinical trials during pandemics. JAMA 2020; 323: 1897-8.
- Öztürk Durmaz Ş, Sümer Coşkun A, Yalçın AN. Clinical and prognostic evaluation of patients admitted to the COVID-19 pandemic unit of the emergency department. J Health Sci Med 2021; 4: 6: 835-9.
- Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nat Rev Drug Discov 2020; 19: 3: 149-50.
- Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci 2017; 93: 7: 449-63.
- Yousefi B, Valizadeh S, Ghaffari H, Vahedi A, Karbalaei M, Eslami M. A global treatments for coronaviruses including COVID-19. J Cell Physiol 2020; 235: 9133-42.
- Tanaka T, Kamiyama T, Daikoku T, et al. T-705 (Favipiravir) suppresses tumor necrosis factor α production in response to influenza virus infection: A beneficial feature of T-705 as an anti-influenza drug. Acta Virol 2017; 61: 48-55.
- Pilkington V, Pepperrell T, Hill A. A review of the safety of favipiravir - a potential treatment in the COVID-19 pandemic? J Virus Erad 2020; 6: 2: 45-51.
- Ghasemnejad-Berenji M, Pashapour S. Favipiravir and COVID-19: a simplified summary. Drug Res (Stuttg) 2021; 71: 166-70.
- Du YX, Chen XP. Favipiravir: pharmacokinetics and concerns about clinical trials for 2019-nCoV infection. Clin Pharmacol Ther 2020; 108: 242-7.
- McCullough PA, Kelly RJ, Ruocco G, et al. Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection. Am J Med 2021; 134: 16-22.
- TC Saglik Bakanligi (Turkish Ministry of Health). COVID-19 (SARS-CoV-2 enfeksiyonu) rehberi. Ankara: Ministry of Health; 2020. Available online: https://COVID19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_ Rehberi.pdf
- Kivrak A, Ulaş B, Kivrak H. A comparative analysis for anti-viral drugs: Their efficiency against SARS-CoV-2. Int Immunopharmacol 2021; 90: 107232.
- Cai Q, Yang M, Liu D, et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering (Beijing) 2020; 6: 10: 1192-8.
- Ivashchenko AA, Dmitriev KA, Vostokova NV, et al. AVIFAVIR for treatment of patients with moderate coronavirus disease 2019 (COVID-19): interim results of a phase II/III multicenter randomized clinical trial. Clin Infect Dis 2021; 73: 531-4.
- Hashemian SM, Farhadi T, Velayati AA. A review on favipiravir: the properties, function, and usefulness to treat COVID-19. Expert Rev Anti Infect Ther 2021; 19: 1029-37.
- Mishima E, Anzai N, Miyazaki M, Abe T. Uric acid elevation by favipiravir, an antiviral drug. Tohoku J Exp Med 2020; 251: 87-90.
- Doi Y, Hibino M, Hase R, et al. A prospective, randomized, open-label trial of early versus late favipiravir therapy in hospitalized patients with COVID-19. Antimicrob Agents Chemother 2020; 64: e01897-20.
- Fujii S, Ibe Y, Ishigo T, et al. Early favipiravir treatment was associated with early defervescence in non-severe COVID-19 patients. J Infect Chemother 2021; 27: 1051-7.
- Godinjak A, Iglica A, Rama A et al. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad 2016; 45: 97-103.
Öz
Aim: Positive results have been reported regarding the early use of favipiravir,a RNA-dependent RNA polymerase inhibitor,in the COVID-19 pandemic. In our study, we aimed to understand the potential role of favipiravir in controlling COVID-19 pneumonia and sepsis by comparing the early use of favipiravir with the late using.
Material and Method: Treatments are carried out in line with the guidelines constantly updated by the Ministry of Health in Turkey. Following the guide published on April 14,2020,we examined 18 patients who received favipiravir as the last treatment option in the late period and 17 patients who received favipiravir in the early period in two different groups.We recorded the demographic characteristics,comorbidities,APACHE-II scores,consecutive SOFA scores and mortality status of the patients in both groups.
Results: The difference between groups in terms of gender and age was not statistically significant.The difference between groups in terms of APACHE-II score was statistically significant.(p=0.018)The late group also had higher APACHE-II scores.The difference between groups in terms of exitus was not statistically significant but lower in the group using favipiravir early.
Conclusion: In studies with a limited number of patients, favipiravir has been shown to have a significant advantage over lopinavir/ritonavir in viral clearance as well as a significant reduction in viral load when used in the early period.Similarly,in our study,patients who used favipiravir in the late period came to us more seriously and the mortality rate was higher. We think that favipiravir had a significant effect even in studies with a small number of patients, and larger studies are needed in this area.
Anahtar Kelimeler
Kaynakça
- Kalil AC. Treating COVID-19-off-label drug use, compassionate use, and randomized clinical trials during pandemics. JAMA 2020; 323: 1897-8.
- Öztürk Durmaz Ş, Sümer Coşkun A, Yalçın AN. Clinical and prognostic evaluation of patients admitted to the COVID-19 pandemic unit of the emergency department. J Health Sci Med 2021; 4: 6: 835-9.
- Li G, De Clercq E. Therapeutic options for the 2019 novel coronavirus (2019-nCoV). Nat Rev Drug Discov 2020; 19: 3: 149-50.
- Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci 2017; 93: 7: 449-63.
- Yousefi B, Valizadeh S, Ghaffari H, Vahedi A, Karbalaei M, Eslami M. A global treatments for coronaviruses including COVID-19. J Cell Physiol 2020; 235: 9133-42.
- Tanaka T, Kamiyama T, Daikoku T, et al. T-705 (Favipiravir) suppresses tumor necrosis factor α production in response to influenza virus infection: A beneficial feature of T-705 as an anti-influenza drug. Acta Virol 2017; 61: 48-55.
- Pilkington V, Pepperrell T, Hill A. A review of the safety of favipiravir - a potential treatment in the COVID-19 pandemic? J Virus Erad 2020; 6: 2: 45-51.
- Ghasemnejad-Berenji M, Pashapour S. Favipiravir and COVID-19: a simplified summary. Drug Res (Stuttg) 2021; 71: 166-70.
- Du YX, Chen XP. Favipiravir: pharmacokinetics and concerns about clinical trials for 2019-nCoV infection. Clin Pharmacol Ther 2020; 108: 242-7.
- McCullough PA, Kelly RJ, Ruocco G, et al. Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) infection. Am J Med 2021; 134: 16-22.
- TC Saglik Bakanligi (Turkish Ministry of Health). COVID-19 (SARS-CoV-2 enfeksiyonu) rehberi. Ankara: Ministry of Health; 2020. Available online: https://COVID19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_ Rehberi.pdf
- Kivrak A, Ulaş B, Kivrak H. A comparative analysis for anti-viral drugs: Their efficiency against SARS-CoV-2. Int Immunopharmacol 2021; 90: 107232.
- Cai Q, Yang M, Liu D, et al. Experimental treatment with favipiravir for COVID-19: an open-label control study. Engineering (Beijing) 2020; 6: 10: 1192-8.
- Ivashchenko AA, Dmitriev KA, Vostokova NV, et al. AVIFAVIR for treatment of patients with moderate coronavirus disease 2019 (COVID-19): interim results of a phase II/III multicenter randomized clinical trial. Clin Infect Dis 2021; 73: 531-4.
- Hashemian SM, Farhadi T, Velayati AA. A review on favipiravir: the properties, function, and usefulness to treat COVID-19. Expert Rev Anti Infect Ther 2021; 19: 1029-37.
- Mishima E, Anzai N, Miyazaki M, Abe T. Uric acid elevation by favipiravir, an antiviral drug. Tohoku J Exp Med 2020; 251: 87-90.
- Doi Y, Hibino M, Hase R, et al. A prospective, randomized, open-label trial of early versus late favipiravir therapy in hospitalized patients with COVID-19. Antimicrob Agents Chemother 2020; 64: e01897-20.
- Fujii S, Ibe Y, Ishigo T, et al. Early favipiravir treatment was associated with early defervescence in non-severe COVID-19 patients. J Infect Chemother 2021; 27: 1051-7.
- Godinjak A, Iglica A, Rama A et al. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad 2016; 45: 97-103.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Yayımlanma Tarihi | 24 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 3 Sayı: 1 |
Cited By
The effect of malignancy on prognosis in ICU patients with COVID-19
Anatolian Current Medical Journal
https://doi.org/10.38053/acmj.1117598
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