Conference Abstract | Volume 8, Abstract ELIC2025179 (Oral 026) | Published: 14 Aug 2025
Cyril Erameh1,2, Kevin Okwaraeke3, Meike Pahlmann4,5, Christine Kleist6, Femi Babatunde1, Ndapewa Ithete4,5, Osahogie Edeawe1, Cédric Mbavu7, Julia Hinzmann4,5, Veronika Schlicker7, Francisca Sarpong7, Camille Fritzell8,9,10, Alexandre Duvignaud8,9,11, Denis Malvy8,9,11,Joseph Okoeguale1,12, Reuben Eifediyi1,12, Sylvanus Okogbenin1,12, Marie Jaspard8,9,10, Sebastian Wicha6, Stephan Günther4, Peter Akhideno1,2, Oluwafemi Ayodeji3, Michael Ramharter7,5, Mirjam Groger7,5
1Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria, 2Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria, 3Infection Control and Research Centre, Federal Medical Centre Owo, Michael Adekun Ajasin Road, PMB 1053, Owo, Ondo State, Nigeria, 4Department of Virology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany, 5German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany, 6Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany, 7Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 8Univ. Bordeaux, Inserm 1219, IRD 271, Bordeaux Population Health, 146 Rue Léo Saignat, F-33076 Bordeaux, France, 9Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954, Abidjan 18, Côte d’Ivoire, 10The Alliance for International Medical Action, Route de l’Aéroport, Rue NG 96, BP 15530, Dakar, Senegal, 11Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, F-33076 Bordeaux, France, 12Department of Obstetrics and Gynecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
&Corresponding author: Cyril Erameh, Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria, Email: cyrilerameh@gmail.com
Received: 24 Mar 2025, Accepted: 09 Jul 2025, Published: 15 Aug 2025
Domain: Infectious Disease Epidemiology
Keywords: Favipiravir, Ribavirin, Lassa fever, Nigeria
©Cyril Erameh et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Cyril Erameh et al., Safety and tolerability of Favipiravir compared to Ribavirin for the treatment of Lassa fever: A randomized controlled open-label phase II clinical trial. Journal of Interventional Epidemiology and Public Health. 2025;8(Conf Proc 5):00026. https://doi.org/10.37432/JIEPH-CONFPRO5-00026
The Lassa virus (LV) causes Lassa fever (LF), a severe re-emerging disease. It affects several West African nations, with Nigeria having the greatest case burden. Currently, only supportive care and ribavirin are available for treatment. There is, however, little evidence on the efficacy of ribavirin in LF. Recent research found that in vivo plasma concentrations are likely insufficient for antiviral effects. Thus, new LF medicines are urgently required. Favipiravir, a broad-spectrum antiviral for pandemic influenza, has also being tested for other viruses. It is effective against LV in pre-clinical trials. The aim of this clinical trial was to evaluate the safety, tolerability and pharmacokinetics of repurposed favipiravir for LF.
LF patients (hospitalized and PCR confirmed) were recruited to this randomized controlled open-label phase II clinical trial in Nigeria’s Irrua Specialist Teaching Hospital and Federal Medical Centre Owo, the world’s biggest LF treatment centres. Patients were randomized in a 1:1 ratio to I.V ribavirin and oral favipiravir. Clinical assessments including ECG, and blood sampling for pharmacokinetics (PK) as well as virological, serological, immunological, haematological, biochemistry analyses were done during screening and thereafter until day 10.
Between August 2021 and October 2022, 41 LF patients were randomized in the study. 36 participants completed follow-up. Treatment Emergent Adverse Events occurred on 16/20 (80%) on favipiravir and 14/21 (66.7%) on ribavirin and were similarly distributed between treatment arms. No severe or serious adverse events were observed under favipiravir. One life-threatening event occurred with ribavirin. PK analysis of favipiravir showed reliable exposure with maximum plasma concentration of 50.9 mg/L in steady state, half-life of 10.9 hours, and AUC(0-240h) of 9275mg/L*h.
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