tetano
Editor, Senior Moderator
PLoS One
. 2025 Jun 4;20(6):e0324903.
doi: 10.1371/journal.pone.0324903. eCollection 2025. In-hospital mortality outcomes of favipiravir in patients with moderate to severe COVID-19 infection: An emulated target trial using real-world data from the largest field hospital in Thailand
Lalita Lumkul[SUP] 1 2 [/SUP], Krittai Tanasombatkul[SUP] 1 3 [/SUP], Phongsak Nitikaroon[SUP] 4 [/SUP], Thotsaporn Morasert[SUP] 5 [/SUP], Phichayut Phinyo[SUP] 1 2 3 [/SUP]
Affiliations
Background: Favipiravir, an antiviral agent, has been widely used to treat COVID-19 due to its potential mechanism of action, despite limited evidence of its efficacy in moderate to severe cases.
Aim: This study aimed to evaluate the efficacy of favipiravir in improving in-hospital mortality outcomes among patients with moderate to severe COVID-19 through an emulation of a target trial.
Methods: We emulated a target trial using observational data from Bussarakham field hospital, Thailand between May 14 and September 20, 2021. Patients were categorized into three groups: those receiving favipiravir with dexamethasone (FPV with Dexa), favipiravir alone (FPV), and symptomatic treatment (ST). In-hospital mortality within 30 days was the primary outcome.
Results: From 18,184 patients admitted to the hospital, a total of 3,193 moderate to severe COVID-19 cases were included. Of these, 2,256 (70.65%) received FPV with Dexa, 828 (25.93%) received FPV, and 109 (3.41%) received ST. The restricted mean survival times were 29.68 days (95% CI: 29.52, 29.84) for FPV with Dexa, 29.46 days (95% CI: 29.22, 29.71) for FPV, and 28.14 days (95% CI: 26.51, 29.76) for ST. Only FPV showed marginally significant difference when compared to ST. However, there was a trend in prolonging survival time in FPV with Dexa group, and the results were more pronounced in severe and hypoxic patients.
Conclusion: Our emulated target trial suggests favipiravir, especially with dexamethasone, offers a modest survival benefit in moderate to severe COVID-19, particularly in hypoxic patients. It supports favipiravir as a practical antiviral in settings where other antivirals are not available. Further randomized controlled studies are needed to confirm its role, alongside standard corticosteroid therapy.
. 2025 Jun 4;20(6):e0324903.
doi: 10.1371/journal.pone.0324903. eCollection 2025. In-hospital mortality outcomes of favipiravir in patients with moderate to severe COVID-19 infection: An emulated target trial using real-world data from the largest field hospital in Thailand
Lalita Lumkul[SUP] 1 2 [/SUP], Krittai Tanasombatkul[SUP] 1 3 [/SUP], Phongsak Nitikaroon[SUP] 4 [/SUP], Thotsaporn Morasert[SUP] 5 [/SUP], Phichayut Phinyo[SUP] 1 2 3 [/SUP]
Affiliations
- PMID: 40465794
- DOI: 10.1371/journal.pone.0324903
Background: Favipiravir, an antiviral agent, has been widely used to treat COVID-19 due to its potential mechanism of action, despite limited evidence of its efficacy in moderate to severe cases.
Aim: This study aimed to evaluate the efficacy of favipiravir in improving in-hospital mortality outcomes among patients with moderate to severe COVID-19 through an emulation of a target trial.
Methods: We emulated a target trial using observational data from Bussarakham field hospital, Thailand between May 14 and September 20, 2021. Patients were categorized into three groups: those receiving favipiravir with dexamethasone (FPV with Dexa), favipiravir alone (FPV), and symptomatic treatment (ST). In-hospital mortality within 30 days was the primary outcome.
Results: From 18,184 patients admitted to the hospital, a total of 3,193 moderate to severe COVID-19 cases were included. Of these, 2,256 (70.65%) received FPV with Dexa, 828 (25.93%) received FPV, and 109 (3.41%) received ST. The restricted mean survival times were 29.68 days (95% CI: 29.52, 29.84) for FPV with Dexa, 29.46 days (95% CI: 29.22, 29.71) for FPV, and 28.14 days (95% CI: 26.51, 29.76) for ST. Only FPV showed marginally significant difference when compared to ST. However, there was a trend in prolonging survival time in FPV with Dexa group, and the results were more pronounced in severe and hypoxic patients.
Conclusion: Our emulated target trial suggests favipiravir, especially with dexamethasone, offers a modest survival benefit in moderate to severe COVID-19, particularly in hypoxic patients. It supports favipiravir as a practical antiviral in settings where other antivirals are not available. Further randomized controlled studies are needed to confirm its role, alongside standard corticosteroid therapy.