• Sarawut Krongsut Department of Internal Medicine, Saraburi Hospital
  • Wipasiri Naraphong Boromarajonani College of Nursing, Saraburi, Faculty of Nursing, Praboromarajchanok Institute
  • Pannaporn Thongsuk Division of Infectious Disease, Department of Internal Medicine, Pichit Hospital
  • Panupong Tantirat Division of Social Medicine, Saraburi Hospital
Keywords: COVID-19, Remdesivir, Favipiravir, Effectiveness, Mortality, Clinical improvement


Background: Antiviral drug administration in the early phase of COVID-19 during peak viremia can reduce the progression to severe disease. The optimal antiviral treatment against severe coronavirus disease 2019 (COVID‐19) has not been proven.

Objective: The study aimed to examine the effectiveness of remdesivir versus favipiravir to treat patients with COVID-19 pneumonia on clinical improvement and mortality.

Methods: This retrospective observational cohort study was conducted in the modular intensive care unit and cohort ward from 1 June 2021 to 31 December 2021. Patients were screened for COVID-19 pneumonia. A propensity score was used to handle selection bias and potential confounding factors. The propensity score estimation was obtained from the multivariable logistic regression model, including prognostic covariates. Then 1:1 matching was performed. Finally, the balance after matching was checked concerning the p-value.

Results: Overall, 362 patients were matched using propensity score analysis; they were enrolled and divided in 2 groups: remdesivir and favipiravir (181:181). Remdesivir was associated with an increased proportion of clinical improvement (70.72 vs. 56.91%, adjusted HR=1.52 [1.16-2.01]; p=0.002), reduced inhospital mortality (adjusted HR=0.68 [0.47-0.99]; p=0.047), an increased proportion of being free from the use of a high flow nasal cannula (HFNC) and a low flow oxygen cannula (LFNC) (74.34 vs. 56.10%, adjusted HR 1.79 [1.32-2.45]; p<0.001; 86.4% vs. 74.8, adjusted HR=1.34 [1.01-1.78]; p=0.037, respectively), increased median survival time (26 vs. 24 days, median survival time difference of 2 days [IQR, 2-6]; p=0.048). In addition, patients treated with remdesivir showed a significantly higher proportion of discharge from the hospital measured using the WHO ordinary scale (66.85 vs. 53.04%, adjusted HR =1.19 [1.01-1.41]; p=0.035).

Conclusion: Among hospitalized patients with COVID-19 pneumonia, receiving oxygen supplementation, remdesivir was associated with increased clinical improvement, reduced in-hospital mortality and reduced need for HFNC and LFNC.


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