# Safety and efficacy of different therapeutic regimens in Egyptian adults with moderate COVID-19 infection (EVEREST): a real-world retrospective study

## TL;DR

This study evaluates different treatment regimens for moderate COVID-19 in Egypt, finding that some antiviral combinations reduced hospitalization and disease progression.

## Contribution

The study provides real-world evidence on the efficacy and safety of repurposed antiviral combinations for treating moderate COVID-19 in Egypt.

## Key findings

- Antiviral combinations reduced hospitalization days and progressive CT scans compared to standard care.
- Sofosbuvir-based regimens showed significant clinical improvement and fewer complications.
- All tested regimens were effective in preventing disease progression in moderate COVID-19 cases.

## Abstract

This study seeks to disseminate insights from Egypt’s management of COVID-19 patients by evaluating the effectiveness and safety of various treatment regimens using combined repurposed antivirals. A retrospective cohort study was conducted on 310 moderate hospitalized COVID-19 cases. Patients were divided into four treatment arms: standard care, sofosbuvir/daclatasvir (sovodak) plus ivermectin, sofosbuvir/ledipasvir (SOF/LED) plus hydroxychloroquine, and SOF/LED plus ivermectin. The study analyzed parameters such as hospitalization days, total clinical recovery percentage, and progressive CT chest changes. The median hospitalization days significantly differed in arm 1 versus arms 2 and 3 (p < 0.001 and p = 0.025, respectively). There was a difference between arms 1 and 4 in the days till clinical improvement (p = 0.007). Complete normalization of vital signs occurred in 26% of arm 4 patients versus 43% in arm 1 (p = 0.023), and a statistically significant difference in the proportion of patients with total clinical recovery was found between arms 1 and 2 (p = 0.009). All arms displayed a statistically significant lower proportion of patients with progressive CT scans compared to arm 1. Our study reveals that most tested antiviral combinations effectively reduced hospitalization days and progressive CT scans. These regimens demonstrated efficacy in treating moderate COVID-19 to prevent disease progression and complications.

The online version contains supplementary material available at 10.1038/s41598-025-23660-1.