Efficacy of Sofosbuvir plus Ledipasvir in Egyptian patients with COVID-19 compared to standard treatment: Randomized controlled trial

Elgohary, M. A.-S.; Hasan, E. M.; Ibrahim, A. A.; Ahmed, M. F.; Abdel-Rahman, R. Z.; Zaki, A. I.; Elaatar, M. B.; Elnagar, M. T.; Emam, M. E.; Hamada, M. M.; Abdel-Hamid, T. M.; Abdel-Hafez, A. S.; Seadawy, M. G.; Fatoh, A. R.; Elsaied, M. A.; Sakr, M. A.-R.; Elkady, A. O.; Shehata, M. M.; Nawar, O. M.; Selem, M. A.-e.; Abd-aal, M. S.; Lotfy, H. H.; Elnagdy, T. R.; Helmy, S.; Mubark, M. A.

Background: COVID-19 is a pandemic disease caused by SARS-CoV-2, which is an RNA virus similar to HCV in the replication process. Sofosbuvir/ledipasvir is an approved drug by the FDA to treat HCV infection. This study investigates the efficacy of Sofosbuvir/ledipasvir as a treatment for patients with moderate COVID-19 infection.. Methods: This is a single-blinded parallel-randomized controlled trial. The participants were randomized equally into the intervention group received Sofosbuvir/ledipasvir (S.L. group), and the control group received Oseltamivir, Hydroxychloroquine, and Azithromycin (OCH group). The primary outcomes were the cure rate over time and the incidence of serious adverse events. The secondary outcomes included the laboratory findings. Results: Two hundred and fifty patients were divided equally into each group. Both groups were similar regarding gender, but age was higher in the S.L. group (p=0.001). In the S.L. group, 89 (71.2%) patients were cured, while only 51 (40.8%) patients were cured in the OCH group. The cure rate was significantly higher in the S.L. group (RR=1.75, p<0.001). Kaplan-Meir plot showed a considerably higher cure over time in the S.L. group (Log-rank test, p=0.032). There were no deaths in the S.L. group, but there were six deaths (4.8%) in the OCH group (RR=0.08, p=0.013). Seven patients (5.6%) in the S.L. group and six patients (4.8%) in the OCH group were admitted to ICU (RR=1.17, P=0.776). There was no significant difference between treatment groups regarding Total Leukocyte Count, Neutrophils count, Lymph, Alanine transaminase, and Urea. Conclusion: Sofosbuvir/ledipasvir is suggestive of being effective in treating patients with moderate COVID-19 infection. Further studies are needed to compare Sofosbuvir/ledipasvir with the new treatment protocols.