Sofosbuvir

Sofosbuvir is an antiviral drug used to treat Hepatitis C (HCV); it targets the virus’ NS5B protein, i.e. HCV’s RNA-dependent RNA polymerase (RdRp).

Affirmative evidence for SARS-CoV-2

• https://pubmed.ncbi.nlm.nih.gov/35134505 (systematic review and meta-analysis)
• https://pubmed.ncbi.nlm.nih.gov/35100985 (systematic review of randomized controlled trials (RCTs) )
• https://pubmed.ncbi.nlm.nih.gov/36327326 (in vitro rescue of infected brain cells)
• https://pubmed.ncbi.nlm.nih.gov/35765613 (n=100 RCT in which hospital stay duration was reduced)
• https://pubmed.ncbi.nlm.nih.gov/35690556 (n=190 multicenter RCT showing early and high viral clearance rate in mild and moderate patients with COVID-19)
• https://pubmed.ncbi.nlm.nih.gov/35388092 (n=120 case-controlled trial showing faster elimination of SARS-CoV-2)
• https://pubmed.ncbi.nlm.nih.gov/35510477 (in silico, but hypothesized to also inhibit fungal RdRp (Rhizopusoryzae species))

Interactions (not exhaustive)

• NICE UK:
  • H1 blockers (Cimetidine, Famotidine) decrease effects of Sofosbuvir.
• Uni. of Alberta / DrugBank:
  • Acyclovir/Valaciclovir may decrease the excretion rate of Sofosbuvir which could result in a higher serum level.
  • Fexofenadine can increase the serum concentration of Sofosbuvir.

Similar drugs

• AT-527
• Tenofovir alafenamide
• Remdesivir

Risks

• Kidney function must be good
• Commonly lowers iron and hemoglobin
• Shingles risk for at least a year after
• CMV reactivation risk (CMV IgM-neg patients; IgG, IgM, vDNA measured)
• Worsens Hep B if present (liver function monitoring)

Patient reviews

• 70% positive, 17% negative for HCV (Drugs.com)
• Mixed results in ME/CFS and Long Covid (Phoenix Rising)