Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): a randomized controlled trial

J Antimicrob Chemother. 2020 Nov 1;75(11):3379-3385. doi: 10.1093/jac/dkaa334.


Background: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19.

Methods: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with under registration number IRCT20200128046294N2.

Results: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported.

Conclusions: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.

Publication types

  • Clinical Trial, Phase III
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / administration & dosage*
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / diagnostic imaging
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / epidemiology
  • Drug Therapy, Combination
  • Female
  • Humans
  • Imidazoles / administration & dosage*
  • Iran / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Patient Admission / trends*
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / epidemiology
  • SARS-CoV-2
  • Severity of Illness Index
  • Sofosbuvir / administration & dosage*
  • Treatment Outcome


  • Antiviral Agents
  • Imidazoles
  • daclatasvir
  • Sofosbuvir