# Retrospective Evaluation of the Efficacy of Combined Antiviral Therapy Versus Monotherapy in High-Risk Hospitalized COVID-19 Patients

## TL;DR

This study compares the effectiveness of combined antiviral therapy versus monotherapy in high-risk hospitalized COVID-19 patients.

## Contribution

The study provides new evidence on the benefits of combining remdesivir and favipiravir for treating high-risk hospitalized patients.

## Key findings

- Combined therapy showed better symptom improvement and oxygen saturation compared to monotherapy.
- Patients on combined therapy had longer survival times and lower mortality rates.
- One-third of participants experienced side effects, with renal and hepatic side effects being most common.

## Abstract

The COVID-19 pandemic has led to a variety of clinical symptoms, ranging from mild respiratory problems to severe pneumonia and multi-organ failure. Remdesivir and favipiravir are approved to treat COVID-19 and are used as single agents in the Ministry of Health (MOH) protocol. However, there is limited research available on the effectiveness of their combined use. The aim of this cross-sectional study is to evaluate the efficacy and safety of remdesivir and favipiravir in reducing disease severity, hospitalization duration, and mortality rates among high-risk patients who have been hospitalized with COVID-19. A retrospective, cross-sectional study was conducted in adult patients who were treated with the MOH treatment protocol. The study period was from January 2021 to January 2022, and it included 47 patients treated with favipiravir or a combination of remdesivir and favipiravir. The study included patients with high-risk characteristics and excluded pediatric and pregnant patients. In a study of 47 hospitalized COVID-19 patients, all admitted cases presented with at least one COVID-19 symptom. The frequency of symptoms such as fever, cough, chest pain, shortness of breath, and fatigue was noted to be, respectively. The median duration of antiviral therapy was seven days (interquartile range (IQR): five to eight days), and one-third of study participants developed side effects due to antiviral administration. The proportions of renal and hepatic side effects were found to be comparable (25.5% and 21.3%, respectively). Furthermore, the frequency of overall symptom improvement on completion of antiviral therapy was found to be 70.2%. An improvement in oxygen saturation was found to be significant with combined antiviral therapy. A total of 10 death events were reported during the study period, yielding 22 poor outcomes per 1000 person-days. COVID-19 patients taking combined therapy had significantly longer survival times compared to those taking a single agent (15 and 23 days, P > 0.05, respectively). The cumulative probability of survival at the end of the study period among those receiving single and combined therapy was found to be 29% and 38%, respectively. The findings from the present study showed that combined remdesivir and favipiravir have a superior effect than single favipiravir medication in treating high-risk hospitalized COVID-19 patients. These results highlight the clinical importance of combined antiviral regimens in enhancing patient prognoses, reducing mortality rates and shortening hospital stays.