{"id":52315,"date":"2023-09-30T11:16:45","date_gmt":"2023-09-30T11:16:45","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=52315"},"modified":"2023-10-07T09:11:21","modified_gmt":"2023-10-07T09:11:21","slug":"the-significance-of-remdesivir-and-favipiravir-therapies-to-survival-of-covid-19-patients","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no3\/the-significance-of-remdesivir-and-favipiravir-therapies-to-survival-of-covid-19-patients\/","title":{"rendered":"The Significance of Remdesivir and Favipiravir Therapies to Survival of COVID-19 Patients"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

The emergence of a novel pandemic caused by COVID-19 poses a\nhuge burden on humanity\u2019s health since the Spanish flu in 1918 exceeding 297\nmillion nearly 7 million casualties by December 2021 worldwide.  By first week of February, 2021,\nconfirmed COVID-19 cases reached\n106 million, mortality recorded over 2 and half millions worldwide1<\/sup>.\nTremendous global efforts by health workers including clinicians and\nresearchers in an attempt to come up with new drug options to seize the\ninfection spread2<\/sup>. Many clinical trials have been conducted, but the\nclinical efficacy of any therapeutic agent for coronavirus disease has not been\nproven yet meanwhile, a few of them (Remdesivir, hINFa-2b, Ribavirin,\nChloroquine, and Arbidol) are ongoing investigated under clinical trials for\ntheir efficacy against the disease3<\/sup>. <\/p>\n\n\n\n

Remdesivir\nwhich is an adenosine triphosphate (ATP) structural analog inserted during RNA\npolymerase instead of the natural substrate into nascent viral RNA resultant in\ndelayed replication due to termination of the chain leading to viral\nreplication inhibition4<\/sup>. Remdesivir was suggested to treat\nSARS-CoV-2 confirmed infection through viral replication during the first week\nof the symptoms starts5<\/sup>. The purine nucleotide favipiravir\nribofuranosyl-5′-triphosphate, often known as favipiravir or T-705, is a\nprodrug whose active ingredient inhibits RNA polymerase, stopping viral replication6,7<\/sup>.\nThe Japan Pharmaceuticals and Medical Devices Agency approved favipiravir for\nuse in 2014 to treat novel and re-emerging influenza virus infection. In vitro\nstudy by Eloy et al., (2020) stated that Favipiravir 50% effective\nconcentration (EC50) against SARS-CoV-2 in Vero E6 cells was 61.88 \u00b5M\/L8<\/sup>.\nFavipiravir, which focused on RNA-dependent RNA polymerase (RdRP) to treat\ninfluenza A, received approval in Japan with an IC50 range of (0.13 to 0.48\nug\/ml)6<\/sup>. Influenza and SARS-CoV-2 are RNA genomes,\nthey showed similar disease manifestations and organ tropism which they rely on\n(RdRp) for replication, their inhibitor Arbidol which they license for\ninfluenza treatment in Asia like Russia and China as an option of standard care\nfor coronavirus disease9,10<\/sup>. Tocilizumab Actemra\u00ae<\/sup> by\nRoche Pharma Company is attached to membrane-bound and soluble receptors of\ninterleukin 6, so it is IgG1 mAb human recombinant. The signaling pathway\ninhibition leads to the reduction the proinflammator activity of the interleukin\n611<\/sup>. <\/p>\n\n\n\n

There are\ncurrently significant efforts being made by researchers to carry out clinical\ntrials and research studies to better understand the biology and clinical\ncharacteristics of COVID-1912<\/sup>. Information about the age and gender\nof patients13,14<\/sup>, as well as the effects of various treatment\nmodalities on morbidity and death15,16<\/sup>.\nHowever, to the best of\nour knowledge, no studies from Iraq have been published to cover these pivotal\naspects. Therefore, this observational study presenting the first study from\nBaghdad province to scrutinize the nature of the COVID-19 infection and to evaluate\nthe impact of the proposed treatment protocols on the treated sample of\nCOVID-19 patients seen in a single center from January to August 2020.\nThe study includes the currently therapeutic regimen used such as Remdesivir,\nActemra\u00ae<\/sup>, and Favipiravir and their effect on time of recovery and\nmortality rate.  <\/p>\n\n\n\n

Patients and Methods<\/strong><\/p>\n\n\n\n

Patients<\/strong><\/p>\n\n\n\n

In this prospective, open-label, single-center observational study,\nadult COVID-19 patients were included. The total number of the patients randomized in this study\nwere 277 confirmed patients with COVID-19, 127 patients were enrolled under\ntherapy protocols beside the supportive treatment and 150 patients were set as a\ncontrol group received only standard care (Figure 1). The subjects were\nresidents at Al-Forat General Hospital, Baghdad through January-August 2020. The single center patients were mostly inpatients and few\nwere outpatients. They were classified according to the disease severity into\nmild-to-moderate patients in which were outpatients and all inpatients were\nsevere and critical patients. The COVID-19 patients were evaluated clinically,\nradiological and confirmed by laboratory polymerase chain reaction (PCR)\ntesting. According to World Health Organization (WHO) recommendations, the\nCOVID-19 patient’s condition was classified as mild, moderate, severe, or\ncritical. The patients were considered recovered according to the symptoms\nvanishing, radiology of chest x-ray or Computerized tomography scan and PCR\nclearance. This study was authorized by the\nscientific committee of the college of science at the University of Baghdad.<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 1: Study flow chart<\/strong><\/p>\n

<\/p>\n

Click here to view figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

COVID-19 Patients Therapy Protocols<\/strong><\/p>\n\n\n\n

If we put in mind that hospital stay\nwas 14 days, and recovery rate from COVID-19 symptoms (fever, fatigue, or\ncoughing) in the treatment groups. Senior medical staff at Al-Forat General\nHospital in Baghdad implemented the treatment guidelines in accordance with\nthose that the Iraqi Ministry of Health had approved. The therapies groups were\nas follows:<\/p>\n\n\n\n

Remdesivir therapy (D1 group)<\/strong><\/p>\n\n\n\n

Remdesivir 200 mg (Intra venous injection) as a\nsingle dose on daily for 3 days, followed by 100 mg once within 7 days of\nsymptom onset17<\/sup>.<\/p>\n\n\n\n

Actemra\u00ae<\/sup> therapy (D2 group)<\/strong><\/p>\n\n\n\n

Actemra\u00ae<\/sup> 80 mg\/4 mL (Intra venous infusion bag) as a single dose once. One further Actemra\u00ae infusion may be given at least eight hours following the initial infusion if clinical signs or symptoms continue to deteriorate or do not improve after the first dose. Favipiravir therapy (D3 group) <\/em><\/p>\n\n\n\n

The Favipiravir dosage is the same\nas the recommended amount for treating influenza, which is 1600 mg given twice\ndaily on day one and 600 mg given twice daily on day two. Favipiravir treatment\nlasted between 7 and 14 days.18,19<\/sup>.<\/p>\n\n\n\n

Control group <\/strong><\/p>\n\n\n\n

According to each patient’s clinical status, the patients in this group only received standard care, which may have comprised all of the following or some of them. The standard of care for SARS-CoV-2 often included supportive therapies such oxygen therapy, antibiotic and anti-inflammatory drugs, and symptomatic medicines, as well as some dietary support. According to the disease severity, patients were provided with COVID-19 standard care adopting the 4th edition of The Protocol for Diagnosis and Treatment of Novel Coronavirus Pneumonia (Table 1).<\/p>\n\n\n\n

Table 1: COVID-19 Patients\u2019 standard care <\/strong><\/p>\n\n\n\n\n\n\n\n
\n

Medication<\/strong><\/p>\n<\/td>\n

\n

Dosage <\/strong><\/p>\n<\/td>\n

\n

Recommendations <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Acetaminophen<\/p>\n

Vitamin C<\/p>\n

Zinc<\/p>\n

Vitamin D3<\/p>\n

Azithromycin<\/p>\n

Dexamethasone <\/p>\n

Methylprednisolone<\/p>\n<\/td>\n

\n

500 mg<\/p>\n

1000 mg<\/p>\n

75-125 mg<\/p>\n

5000 IU<\/p>\n

250 mg\/day<\/p>\n

6 mg<\/p>\n

40 mg<\/p>\n<\/td>\n

\n

On need<\/p>\n

Twice \/ day<\/p>\n

Daily<\/p>\n

Daily<\/p>\n

Daily for five days course<\/p>\n

Daily, if needed<\/p>\n

twice per day, if needed<\/p>\n<\/td>\n<\/tr>\n

\n

Oxygen therapy\/ C-Pap<\/p>\n

Mechanical ventilation<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

If needed<\/p>\n

If needed<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Assessing study endpoints  <\/strong><\/p>\n\n\n\n

 The mortality rate and the recovery time were\nassessed in current study. For each of the three protocol therapies, the\npatients’ survival, progression, and\/or recovery were compared to those\nreceiving only conventional treatment in the control group.<\/p>\n\n\n\n

Recovery Time<\/strong><\/p>\n\n\n\n

The time required to heal from the\ntime of taking therapy.<\/p>\n\n\n\n

Mortality Rate<\/strong> <\/p>\n\n\n\n

The patients with mild-to-moderate,\nsevere, or critical patients in therapy protocol group comparing to controls.<\/p>\n\n\n\n

Statistical analysis<\/strong><\/p>\n\n\n\n

The PSS software Version (SAS Institute,\nCary, North Carolina) was used to perform the statistical analyses, two-sided,\nwith p < 0.05 being considered statistically significant. Continuous\nvariables were presented with mean \u00b1 standard deviation, and compared with\nindependent t-test. Count (percentage) was used to summarize the categorical\nvariables comparing with Chi-square tests.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Patients’\nclinical characteristics<\/strong><\/p>\n\n\n\n

About 127 COVID-19 patients were\nenrolled; their average age was\n46.7 years, and they ranged in age from 23 to 87 years. Of these\npatients, 37% were men and 63% were women. The controls age and gender were\nmatched, their mean age (50.3.2\u00b19.5 year) with 48% male and 52% females (P >\n0.05) (Figure 2) (Table 2).  The status\nof COVID-19 patients through January to August 2020. The percentage of patients\nunder the therapies protocol were shown in Figure 3. There were had high\nrecovery rate with 75.6% and 15.7% of patients were deceased (Figure 4). <\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 2:<\/strong> Gender of COVID-19 patients<\/strong><\/p>\n

<\/p>\n

Click here to view figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 2: Basic characteristics of the patients <\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variables<\/strong><\/p>\n<\/td>\n

\n

Remdesivir group<\/strong><\/p>\n

(N = 78)<\/strong><\/p>\n<\/td>\n

\n

Actemra\u00ae<\/sup> group<\/strong><\/p>\n

(N = 9 )<\/strong><\/p>\n<\/td>\n

\n

Favipiravir group<\/strong><\/p>\n

(N = 40)<\/strong><\/p>\n<\/td>\n

\n

Control group (N = 150)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Gender, n (%) <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Male<\/p>\n<\/td>\n

\n

34 (44%)<\/p>\n<\/td>\n

\n

2 (22%)<\/p>\n<\/td>\n

\n

11 (27%)<\/p>\n<\/td>\n

\n

88 (59%)<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

44 (56%)<\/p>\n<\/td>\n

\n

7 (78%)<\/p>\n<\/td>\n

\n

29 (73%)<\/p>\n<\/td>\n

\n

62 (41%)<\/p>\n<\/td>\n<\/tr>\n

\n

Age (years), n (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

< 65<\/p>\n<\/td>\n

\n

54 (69%)<\/p>\n<\/td>\n

\n

5 (56%)<\/p>\n<\/td>\n

\n

30 (75%)<\/p>\n<\/td>\n

\n

98 (65%)<\/p>\n<\/td>\n<\/tr>\n

\n

\u2265 65<\/p>\n<\/td>\n

\n

24 (31%)<\/p>\n<\/td>\n

\n

4 (44%)<\/p>\n<\/td>\n

\n

10 (25%)<\/p>\n<\/td>\n

\n

52 (35%)<\/p>\n<\/td>\n<\/tr>\n

\n

Clinical Classification, n (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Mild-to-Moderate<\/p>\n<\/td>\n

\n

47 (60%)<\/p>\n<\/td>\n

\n

6 (67%)<\/p>\n<\/td>\n

\n

33 (82%)<\/p>\n<\/td>\n

\n

150 (100%)<\/p>\n<\/td>\n<\/tr>\n

\n

Sever<\/p>\n<\/td>\n

\n

17 (22%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

4 (10%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Critical<\/p>\n<\/td>\n

\n

14 (18%)<\/p>\n<\/td>\n

\n

3 (33%)<\/p>\n<\/td>\n

\n

3 (8%)<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\n\n

Figure 3: <\/strong>Patients under the therapy protocols<\/strong><\/p>\n

<\/p>\n

Click here to view figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
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Figure 4:<\/strong> COVID-19 patients\u2019 status under the protocol therapy<\/strong><\/p>\n

<\/p>\n

Click here to view figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Recovery Time <\/strong><\/p>\n\n\n\n

The recovery time was significantly reduced in the Remdesivir therapy (D1) comparing to controls, the mean time in group D1 was 6.23\u00b12.1days, and the recovery mean time in control group, 3.22\u00b12.1days (P<0.05). Hence, Remdesivir drug lowered healing mean time   to 6 days in mild-to-moderate (Table 3).<\/p>\n\n\n\n

Table 3: Time of recovery of COVID-19 patients(Days) in protocol therapy.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Variables<\/strong><\/p>\n<\/td>\n

\n

Patients subgroup<\/strong><\/p>\n<\/td>\n

\n

Remdesivir<\/strong><\/p>\n<\/td>\n

\n

Actemra\u00ae<\/sup><\/strong><\/p>\n<\/td>\n

\n

Favipiravir<\/strong><\/p>\n<\/td>\n

\n

Control<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Total <\/strong><\/p>\n<\/td>\n

\n

N = 127<\/strong><\/p>\n<\/td>\n

\n

N = 78<\/strong><\/p>\n<\/td>\n

\n

N = 9<\/strong><\/p>\n<\/td>\n

\n

N = 40<\/strong><\/p>\n<\/td>\n

\n

N=150<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Time of recovery (day)<\/strong><\/p>\n<\/td>\n

\n

Total<\/p>\n<\/td>\n

\n

8.52\u00b15.2<\/p>\n<\/td>\n

\n

5.33\u00b12.2<\/p>\n<\/td>\n

\n

16.9\u00b15.4<\/p>\n<\/td>\n

\n

3.22\u00b12.1<\/p>\n<\/td>\n<\/tr>\n

\n

Mild-to-Moderate<\/p>\n<\/td>\n

\n

6.23\u00b12.1<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

12.44\u00b16.6<\/p>\n<\/td>\n

\n

5.24\u00b13.2<\/p>\n<\/td>\n<\/tr>\n

\n

Sever<\/p>\n<\/td>\n

\n

17.25\u00b18.2<\/p>\n<\/td>\n

\n

3.24\u00b13.4<\/p>\n<\/td>\n

\n

21.20\u00b18.7<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Critical<\/p>\n<\/td>\n

\n

15.75\u00b13.4<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Mortality rate<\/strong><\/p>\n\n\n\n

The mortality rate was 14\/64 patients (22%) in critical COVID-19\npatients in D1 group, 3\nout of 37 patients (8%) in D2 group, and 3 out of 9 patients (33%) in\ngroup D3 (P=0.052). The infected patients taken Remdesivir drug were reduced\nregarding the death rate especially in COVID-19 critical cases, which in Iraq\nat the time of performing this observational study was might reach higher than\nabove 50% according to on world data.<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 5: <\/strong>Mortality rate of patients with COVID-19 under the protocol therapy and control group<\/strong><\/p>\n

<\/p>\n

Click here to view figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

SARS-CoV2 is\nnovel virus which is require emergence of effective treatment methods, the\nvaccine was not an option during the first wave of the epidemic. There was an\nurgently need to a new antiviral agent against SARS-CoV-2 to be applied. In\nthis observational study, the aim was to screen the antiviral therapy protocol\nsince January to end of August 2020 in a single health\ncenter (Tables 1 and 2). The COVID-19 treatment current recommendations as in\nTable 3. <\/p>\n\n\n\n

Remdesivir\nhas a high potential in many clinical trials to treat moderate to severe case,\nlowering required time to improve, and reducing mortality20<\/sup>. A\nplacebo-controlled experiment was done by Beigel et al. (2020) on 1062\nindividuals, 541 of whom were given Remdesivir and 521 received a placebo. The\nmedian recovery duration was 10 days (95% confidence interval [CI], 9 to 11\ndays) for Remdesivir recipients compared to 15 days (95% CI, 13 to 18) for\nplacebo recipients. By day 15, the mortality rate was 6.7% in the Remdesivir group and\n11.9% in the placebo group.  The study\nfound that Remdesivir reduced the amount of time adults hospitalized with\nCOVID-19 needed to recover more quickly than a placebo21<\/sup>.  <\/p>\n\n\n\n

Spinner et al.\n(2020) conducted a randomized, open-label trial of hospitalized patients in\nwhich Remdesivir-treated patients were compared with standard care included 596\npatients (including 584 patients with moderate COVID-19), and the trial results\nshowed that patients randomized to a 5-day course of Remdesivir had a\nstatistically significant difference in clinical status compared with those\nreceiving standard care.22<\/sup>. The aforementioned clinical trials come\nin close contact with what this observational study try to highlighted in this\nsingle center (Al-Forat General Hospital) which is worked in line with\ninternational protocols (COVID-19 Treatment Guidelines Panel, 2021)23<\/sup>.\n<\/p>\n\n\n\n

It is important\nto note that this study concurs with a local study carried out by Darweesh et\nal. (2021) in the Kirkuk province, which highlighted the effectiveness of five\ndifferent therapeutic protocols adopted by the healthcare system in Iraq in\nreference to WHO guidelines for management of COVID-19 infection and its\nrelationship to mortality rate. This information may be useful for doctors and\nhealthcare providers in choosing the most appropriate therapeutic regimens24<\/sup>.  <\/p>\n\n\n\n

However, this\nstudy disagrees with Goldman et al. (2020) study, which performed an open-label\ntrial among 397 patients underwent randomization compared to standard care to\nevaluate the efficacy and safety of treatment with Remdesivir for 5 or 10 days\nin patients with severe COVID-19 patients. This study came to the conclusion\nthat severe COVID-19 patients did not need the mechanical ventilation and that\nthere were no significant differences for the both course duration of\nRemdesivir25<\/sup>.<\/p>\n\n\n\n

A\nstudy by Chen and colleagues (2021), in China carried out open-label trail in\nmulti-center to evaluate 2 therapy protocols for treating COVID-19 confirmed\npatients (Favipiravir Versus Arbidol), included 240 patients. Those under\nFavipiravir revealed tendency toward improvement in a week period, especially\nmoderate case (71%) versus (56. %) respectively, as well as an earlier lowered\nin temperature and cough clearance26<\/sup>. Another\nopen-labeled nonrandomized study by (Cai et al., 2020) from China compared the effect of Favipiravir\nVersus lopinavir\/ritonavir among mild-to-moderate COVID-19 cases. The study\nincluded 56 patients in which 35 patients were treated by Favipiravir. The\nauthors concluded to safety of Favipiravir administration with no side effects.\nFavipiravir was used to treat 68% of patients’ fevers, which resolved in 3 days\nas opposed to 6 days in the control group (standard of care).27<\/sup>.  <\/p>\n\n\n\n

The systematic\nand meta-analysis review conducted by Manabe et al. in 2021 concluded that\nFavipiravir had a great promise for treating COVID-19 patients. Favipiravir\nenhanced viral clearance in patients with mild-to-moderate COVID-19 after 7\ndays of treatment, which is consistent with the results of this observational\ntrial28,29<\/sup>. According to Brahmantya et al. (2021), oseltamivir or\nfavipiravir, which is regarded as administering an antibiotic and has become\nroutine therapy in Indonesia, is the antiviral that is advised in that country.\nOseltamivir or favipiravir are still prescribed according to the Indonesian\nCOVID-19 management guideline, despite the fact that the WHO does not advise\ndoing so30<\/sup>.<\/p>\n\n\n\n

A meta-analysis\nof observational studies investigating the effectiveness of tocilizumab on\nCOVID-19 patient mortality was carried out by Malgie et al. in 2021. Ten\nstudies including Tocilizumab therapy were included in the analysis, totaling\n1358 patients. The findings showed that Tocilizumab group mortality was lower\nthan control group mortality. Patients who took tocilizumab had a mortality rate\nthat was (12%) lower than that of controls31<\/sup>. Ten randomized\ncontrolled trials examining Tocilizumab’s effectiveness in COVID-19 patients\nwere included in a review by Arthur et al. (2021). Standard care was provide to\nthe control group. The primary findings were recorded mortality in the (28 to\n30 day). A nearly 6500 were enrolled, around 3400 patients (52%) were treated\nby Tocilizumab. The therapy group was declined mortality (24 % versus<\/em>\n29%)32<\/sup>, meanwhile; Rosas et al (2021) study findings was not conclusive,\nmortality at day 28 was (20 %) under the Tocilizumab therapy and (19%) under\nthe placebo33<\/sup>. Due to the few numbers of patients included in the\ncurrent observational study who had been given Tocilizumab, we can roll out the\nefficacy effect of Tocilizumab. <\/p>\n\n\n\n

Study\nlimitations<\/strong> <\/p>\n\n\n\n

This study has\na number of limitations, including the observational design, which may not\naccount for all risk factors other than age, gender, and clinical\nclassification, such as co-existing chronic conditions, which frequently\nnecessitate the referral of patients to hospitals with a higher level of\nexpertise. Second, it is exceedingly challenging to undertake a thorough study\nin the midst of such a public health catastrophe. Third, given the length of\nthe patient’s hospital stay, the follow-up period was quite brief. Four, access\nto such information is closely controlled by higher authorities and was at\ntimes prohibited in the initial few months of the pandemic. The data were\ngathered based on hospital registry data. <\/p>\n\n\n\n

Conclusions <\/strong><\/p>\n\n\n\n

Health care providers\nare facing tremendous efforts in supplying pharmaceutical care. The\nsymptomatology of COVID-19 are varied among patients, the therapy required to\nbe designed towards certain symptoms as well as towards the progression of the\ninfection among patients.  Remdesivir and Favipiravir therapy tend to have a promising\nefficacy in reducing the mortality rate and time of\nrecovery especially among mild-to-moderate patients.<\/p>\n\n\n\n

Acknowledgment<\/strong><\/p>\n\n\n\n

The author would like to thank all the medical staff in Al-Forat\nGeneral Hospital, Baghdad for their cooperation, thanks are extended to all\npatients who agree to share their affliction through that difficult period.<\/p>\n\n\n\n

Conflict of Interests <\/strong><\/p>\n\n\n\n

The authors claim that there are no conflicting\ninterests.<\/p>\n\n\n\n

Funding Sources<\/strong><\/p>\n\n\n\n

There is no funding sources<\/p>\n\n\n\n

References <\/strong><\/p>\n\n\n\n

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