Favipiravir in patients hospitalised with COVID-19 (PIONEER trial): a multicentre, open-label, phase 3, randomised controlled trial of early intervention versus standard care

BACKGROUND

COVID-19 has overwhelmed health services globally. Oral antiviral therapies are licensed worldwide, but indications and efficacy rates vary. We aimed to evaluate the safety and efficacy of oral favipiravir in patients hospitalised with COVID-19.

METHODS

We conducted a multicentre, open-label, randomised controlled trial of oral favipiravir in adult patients who were newly admitted to hospital with proven or suspected COVID-19 across five sites in the UK (n=2), Brazil (n=2) and Mexico (n=1). Using a permuted block design, eligible and consenting participants were randomly assigned (1:1) to receive oral favipiravir (1800 mg twice daily for 1 day; 800 mg twice daily for 9 days) plus standard care, or standard care alone. All caregivers and patients were aware of allocation and those analysing data were aware of the treatment groups. The prespecified primary outcome was the time from randomisation to recovery, censored at 28 days, which was assessed using an intention-to-treat approach. Post-hoc analyses were used to assess the efficacy of favipiravir in patients aged younger than 60 years, and in patients aged 60 years and older. The trial was registered with clinicaltrials.gov, NCT04373733.

FINDINGS

Between May 5, 2020 and May 26, 2021, we assessed 503 patients for eligibility, of whom 499 were randomly assigned to favipiravir and standard care (n=251) or standard care alone (n=248). There was no significant difference between those who received favipiravir and standard care, relative to those who received standard care alone in time to recovery in the overall study population (hazard ratio [HR] 1·06 [95% CI 0·89-1·27]; n=499; p=0·52). Post-hoc analyses showed a faster rate of recovery in patients younger than 60 years who received favipiravir and standard care versus those who had standard care alone (HR 1·35 [1·06-1·72]; n=247; p=0·01). 36 serious adverse events were observed in 27 (11%) of 251 patients administered favipiravir and standard care, and 33 events were observed in 27 (11%) of 248 patients receiving standard care alone, with infectious, respiratory, and cardiovascular events being the most numerous. There was no significant between-group difference in serious adverse events per patient (p=0·87).

INTERPRETATION

Favipiravir does not improve clinical outcomes in all patients admitted to hospital with COVID-19, however, patients younger than 60 years might have a beneficial clinical response. The indiscriminate use of favipiravir globally should be cautioned, and further high-quality studies of antiviral agents, and their potential treatment combinations, are warranted in COVID-19.

FUNDING

LifeArc and CW+.

New Early Warning Score: EMS Off-Label Use in Out-of-Hospital Patients

Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization.

Light scattering properties of self-organized nanostructured substrates for thin-film solar cells

We investigate the scattering properties of novel kinds of nano-textured substrates, fabricated in a self-organized fashion by defocused ion beam sputtering. These substrates provide strong and broadband scattering of light and can be useful for applications in thin-film solar cells. In particular, we characterize the transmitted light in terms of haze and angle-resolved scattering, and we compare our results with those obtained for the commonly employed Asahi-U texture. The results indicate that the novel substrate has better scattering properties compared to reference Asahi-U substrates. We observe super-Lambertian light scattering behavior in selected spectral and angular regions due to the peculiar morphology of the nano-textured interface, which combines high aspect ratio pseudo random structures with a one-dimensional periodic pattern. The enhancement of light absorption observed in a prototype thin film semiconductor absorber grown on nano-textured glass with respect to an Asahi-U substrate further confirms the superior light trapping properties of the novel substrate.

Self-organized broadband light trapping in thin film amorphous silicon solar cells

Nanostructured glass substrates endowed with high aspect ratio one-dimensional corrugations are prepared by defocused ion beam erosion through a self-organized gold (Au) stencil mask. The shielding action of the stencil mask is amplified by co-deposition of gold atoms during ion bombardment. The resulting glass nanostructures enable broadband anti-reflection functionality and at the same time ensure a high efficiency for diffuse light scattering (Haze). It is demonstrated that the patterned glass substrates exhibit a better photon harvesting than the flat glass substrate in p-i-n type thin film a-Si:H solar cells.

Circular dichroism in the optical second-harmonic emission of curved gold metal nanowires

Here we report the experimental observation of circular dichroism in the second-harmonic field (800-400 nm conversion) generated by self-organized gold nanowire arrays with subwavelength periodicity (160 nm). Such circular dichroism, raised by a nonlinear optical extrinsic chirality, is the evident signature of the sample morphology. It arises from the curvature of the self-assembled wires, producing a lack of symmetry at oblique incidence. The results were compared, both in the optical linear and nonlinear regime, with a reference sample composed of straight wires. Despite the weak extrinsic optical chirality of our samples (not observable by our optical linear measurements), high visibility (more than 50%) was obtained in the second-harmonic generated field.