Evaluation of the effect of sofosbuvir and daclatasvir in hospitalized COVID-19 patients: a randomized double-blind clinical trial (DISCOVER)

Background

The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19.

Methods

This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O₂ saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1.

Results

Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95–1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77–1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality.

Conclusions

We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients.

The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19

OBJECTIVES

Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19.

METHODS

Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT-PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm 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 primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality.

RESULTS

Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04-0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1-12.1, P < 0.01).

CONCLUSIONS

Given these encouraging initial results, and the current lack of treatments proven to decrease mortality in COVID-19, further investigation in larger-scale trials seems warranted.

Effects of growth technique on the microstructure of CuInSe2 ternary semiconductor compound

X-ray diffraction (XRD) and Energy-dispersive X-ray fluorescence spectrometer (EDXRF) are employed to investigate the microstructure of bulk CuInSe2 specimens grown through the Bridgman technique and traveling heater process, respectively. We investigate the lattice parameters, grain sizes, and microstrains of the two grown samples. For a crystal grown by the vertical Bridgeman method, the vacancy VCu serves as an acceptor, resulting in p-type conduction, whereas the vacancy VSe expected to serve as a donor, occurring in n-type conduction for the crystal grown via the traveling heater technique. The concentration of crystal grown via the VBM is determined to be p-type, whereas the concentration of that grown via the THM is n-type. Concerning CuInSe2 crystal, the determined crystallite sizes obtained to be 165 and 182 nm for the VBM and THM, respectively.

Growth and anisotropy of transport properties of CuGaSe 2 single crystals

Single crystals of C u G a S e 2 are prepared by a technique based on the vertical Bridgman procedure. The crystal chemical and phase compositions were identified by using dispersive X-ray fluorescence spectrometry and X-ray diffraction data analysis, respectively. The Hall effect and the electrical conductivity were determined in terms of temperature, parallel and orthogonal to the layer surface, and the parameters proved to be strongly anisotropic. From carried out measurements, different parameters such like the carrier mobilities, the carrier concentration, the relaxation time, the diffusion coefficient, and the length of diffusion for both, majority carriers and minority carriers were estimated.

A Recyclable Heterogeneous Copper(II) Schiff Base Catalyst for the O-Arylation Reaction of Phenols with Aryl Halides

Immobilisation of copper acetate onto a modified polystyrene provided a polymer-supported copper(II) Schiff base catalyst, which is effective in the O-arylation reaction of phenols with aryl halides to give diaryl ethers in high yields. This catalyst is air-stable and was recycled for five times with minimal loss of activity.

An efficient and reusable polymer-supported palladium catalyst for the Suzuki cross-coupling reactions of aryl halides

A reusable, air-stable polymer-anchored palladium (II) Schiff base complex catalyst, P-[{(NCH)C6H4}Pd(OAc)]2 was prepared and was found to be highly active in Suzuki cross-coupling reactions of aryl halides with phenyl boronic acid in an aqueous medium to give biaryl products in high yields.

Mitosis in the oesophageal epithelium of rats during chronic antithyroid treatment with carbimazole

The mitotic activity of the oesophageal epithelium of male rats maintained under carefully controlled conditions was studied, using the metaphase-arrest agent, vincristine sulphate. The accumulation of metaphases was linear (r = 0.97). In untreated rats there was a clear mitotic rhythm with a peak metaphase index (expressed as a percentage) of 12.4 +/- 0.86 (S.E.M.) at 12.00-15.00 h and a trough of 1.3 +/- 0.35 at 24.00 h. The overall mean metaphase index was 5.4 +/- 0.76. The effect of treatment with the antithyroid agent, carbimazole (0.1 g/100 ml in the drinking water), for 3 weeks was to depress the higher values at 12.00-18.00 h (P less than 0.01), while leaving the overall index unchanged. Carbimazole caused a significant (P less than 0.01), transient 40% increase in the metaphase index after 2 days; thereafter the metaphase index remained at control levels until 12 weeks of treatment when a steady decline occurred until 24 weeks. The results are in contrast to those in previously described experiments on thyroid follicular cells which show a large increase in the first few days of treatment, followed by a steady decline towards control levels at 12 weeks. The metabolic activity of the animals is about 50% of normal at 12 weeks when both the oesophageal epithelium and the thyroid follicular cells begin to show a reduction in proliferative activity.

Sex steroid levels in developing and adult male and female zebra finches (Poephila guttata)

Serum samples from male and female zebra finches ranging in age from 1 day before hatch to 54 days posthatch were assayed for 17 beta-estradiol (E), androgen, testosterone (T), or 5 alpha-dihydrotestosterone (DHT). Additional samples were assayed from intact and gonadectomized adults, gonadectomized adults with intraperitoneal implants of testosterone propionate (TP) or estradiol benzoate (EB), gonadectomized nestlings, and nestlings injected subcutaneously with EB. DHT levels of developing birds did not vary as a function of either sex or age. During development, average androgen and T levels were highest during the nestling period, prior to sexual maturation, and were higher in females than in males. Endogenous androgen levels of most subjects that were sampled repeatedly rose and then declined between 24 and 49 days. TP implants produced higher T levels in adult females than in adult males. Levels of E were higher in both sexes during the hatching period (Days -1 through 0) than during the nestling period (Days 2 through 14). A greater number of males than females had relatively high E levels on Days 12 and 14 and during the second week overall. There was no sex difference in levels of E in adults, and gonadectomized adults had markedly higher E levels than intact adults. Gonadectomized nestlings had the same androgen and E levels as intact nestlings of the same age; EB injected nestlings had elevated E levels. The present results indicate specific endocrine changes that mirror events crucial to sexual differentiation of endocrine and behavioral components of reproduction, and have important implications for models of sexual differentiation in zebra finches.

Effect of coccidiosis on reproductive maturation of male Japanese quail

The effects of coccidiosis on reproductive development of male Japanese quail were examined. Male Japanese quail were exposed to high (5 x 10(5) sporulated oocysts/quail) or low (5 x 10(3) sporulated oocysts/quail) doses of Eimeria uzura at 16 or 30 days of age and sampled at 37 days. Quail given high doses of coccidia had reduced testes weight and lowered circulating concentrations of androgen compared with control males. Low doses of coccidia did not affect testes weight but did result in elevated plasma androgen levels. There were no differences in average testes weights by 51 days; however, plasma androgen was still reduced in most groups. To study the effects of coccidiosis on egg production, males exposed to high doses of coccidia at 16 (16H) or 30 (30H) days of age were mated with control females, and control males were mated with control or 16H females. The onset of laying was delayed for 5 days in the control male: 16H female group. During the first week of production, eggs from females bred to 30H males had lower fertility and hatchability than those bred to control or 16H males. By the third week of production, levels of fertility were similar. Apparently, exposure of quails to coccidiosis before sexual maturation might result in long-term effects on later reproductive capability.