Evaluating the use of sofosbuvir and daclatasvir for treatment of COVID-19

Reviewed by Emily Henderson, B.Sc.Aug 24 2020

Several new papers in Journal of Antimicrobial Chemotherapy, published by Oxford University Press, suggest successful treatments for COVID-19.

Three articles all researched the use of sofosbuvir and daclatasvir for the treatment of COVID-19. These three papers come from Iran, which has developed its own pill containing sofosbuvir and daclatasvir, and is in a position to test this in a large clinical trial as Iran is a massively impacted country, reporting some 2500 cases and 200 deaths a day.

Currently no effective antiviral therapy has been found to treat COVID-19. The aim of the trials was to assess if the addition of sofosbuvir and daclatasvir, a drug combination commonly used for the treatment of hepatitis C, improved clinical outcomes in patients with moderate or severe COVID-19.

In one trial, researchers recruited 66 patients and allocated them to either the treatment group or the control group. Clinical recovery within 14 days was achieved by 88% in the treatment group and 67% in the control group. The treatment group had a significantly shorter median duration of hospitalization (6 days) than the control group (8 days). Cumulative incidence of hospital discharge was significantly higher in the treatment group versus control. Three patients died in the treatment group and five in the control group. No serious adverse events were reported.

In another study, subjects suffering from COVID-19 were divided into two groups with one group receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine.

The results indicated that median duration of stay was five days for the sofosbuvir/daclatasvir group and nine days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 6% and 33% for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17%.

The results of these studies suggest that the addition of sofosbuvir and daclatasvir to standard care may reduce the duration of hospital stays for COVID-19 patients compared to standard care alone.

Despite the encouraging initial results, it is too early to reach a verdict. Larger, well-designed studies are required to confirm our results. A network of five randomised clinical trials has been set up, to test sofosbuvir plus daclatasvir in over 2000 patients with COVID-19, in Iran, Brazil, Egypt, and South Africa. By October, we should know if this treatment could be approved for worldwide use."

Shahin Merat, lead author of one of the Journal of Antimicrobial Chemotherapy articles