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Mode of Action
Favipiravir inhibits the RNA-dependent RNA polymerase (RdRp) — an enzyme that allows the coronavirus to replicate inside host cells.Inside the cells, favipiravir is converted to favipiravir ribofuranosyl-5′-triphosphate (favipiravir-RTP) by host cells. This molecule then blocks the RdRp enzyme of SARS-CoV-2, the virus that causes Covid-19.According to a statement by Glenmark, favipiravir works only during the earlier stages of the disease, when the viral replication is higher, but the body's immune response has not gone into overdrive.
Metabolism of favipiravir to its triphosphate form occurs in an extracellular environment in a concentration-dependent manner. The vRNA polymerase mistakenly recognizes favipiravir-RTP as a purine
nucleotide. This favipiravir-RTP is misincorporated in nascent vRNA, or it may act by binding to conserved polymerase domains, preventing incorporation of nucleotides for vRNA replication and
transcription (Jin et al., 2013).
History
Favipiravir is a broad-spectrum antiviral drug that was cleared by the Drugs Controller General of India (DCGI) last week for “emergency restricted” use among Covid-19 patients. Glenmark will sell the generic favipiravir under the brand name FabiFlu.
Favipiravir was originally developed in the late 1990s by a company that was later purchased by the Japanese firm Fujifilm as part of its transition from the photo business to healthcare.
After being tested against a range of viruses, the drug was approved in Japan in 2014 for emergency use against flu epidemics or to treat new strains of influenza.
A Potential Antiviral for COVID-19?
Currently, there is not any specific effective antiviral treatment for COVID-19. Although most of the COVID-19 patients have mild or moderate courses, up to 5%–10% can have severe, potentially life threatening course, there is an urgent need for effective drugs. Optimized supportive care remains the mainstay of therapy. There have been more than 300 clinical trials going on, various antiviral and immunomodulating agents are in various stages of evaluation for COVID-19 in those trials and some of them will be published in the next couple of months. Despite the urgent need to find an effective antiviral treatment for COVID-19 through randomized controlled studies, certain agents are being used all over the world based on either in-vitro or extrapolated evidence or observational studies. The most frequently used agents both in Turkey and all over the world including chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir and remdesivir will be reviewed here .Nitazoxanide and ivermectin were also included in this review as they have recently been reported to have an activity against SARS-CoV-2 in vitro and are licensed for the treatment of some other human infections.