Favipiravir (T-705) Inhibits Junin Virus Infection and Reduces Mortality in a Guinea Pig Model of Argentine Hemorrhagic Fever

Background Junin virus (JUNV), the etiologic agent of Argentine hemorrhagic fever (AHF), is classified by the NIAID and CDC as a Category A priority pathogen. Presently, antiviral therapy for AHF is limited to immune plasma, which is readily available only in the endemic regions of Argentina. T-705 (favipiravir) is a broadly active small molecule RNA-dependent RNA polymerase inhibitor presently in clinical evaluation for the treatment of influenza. We have previously reported on the in vitro activity of favipiravir against several strains of JUNV and other pathogenic New World arenaviruses. Methodology/Principal Findings To evaluate the efficacy of favipiravir in vivo, guinea pigs were challenged with the pathogenic Romero strain of JUNV, and then treated twice daily for two weeks with oral or intraperitoneal (i.p.) favipiravir (300 mg/kg/day) starting 1-2 days post-infection. Although only 20% of animals treated orally with favipiravir survived the lethal challenge dose, those that succumbed survived considerably longer than guinea pigs treated with placebo. Consistent with pharmacokinetic analysis that showed greater plasma levels of favipiravir in animals dosed by i.p. injection, i.p. treatment resulted in a substantially higher level of protection (78% survival). Survival in guinea pigs treated with ribavirin was in the range of 33-40%. Favipiravir treatment resulted in undetectable levels of serum and tissue viral titers and prevented the prominent thrombocytopenia and leucopenia observed in placebo-treated animals during the acute phase of infection. Conclusions/Significance The remarkable protection afforded by i.p. favipiravir intervention beginning 2 days after challenge is the highest ever reported for a small molecule antiviral in the difficult to treat guinea pig JUNV challenge model. These findings support the continued development of favipiravir as a promising antiviral against JUNV and other related arenaviruses. Author Summary Argentine hemorrhagic fever (AHF) is a severe and often-fatal disease caused by infection with Junin virus (JUNV). Presently, there is an unmet need to develop new therapeutics to address current medical, public health and national security concerns, as JUNV is considered a potential bioterror agent amenable to aerosolization and intentional release. In the present study, favirpiravir, a promising anti-JUNV drug in clinical development for the treatment of influenza, was evaluated in an experimental small animal model of AHF. Guinea pigs challenged with JUNV were treated with favipiravir twice daily for two weeks starting 1-2 days after infection. Consistent with pharmacokinetic analysis that showed greater plasma levels of favipiravir in animals dosed by intraperitoneal injection, administration by this route resulted in a dramatic protective effect as 78% animals survived the infection compared to 11% in the placebo-treated group. Favipiravir treatment inhibited JUNV replication and prevented the development of disease observed in animals receiving placebo during the acute stage of infection. The high level efficacy observed following post-exposure prophylaxis with favipiravir is the highest ever reported for a small molecule antiviral in the guinea pig JUNV challenge model and thus supports its continued development as a promising antiviral therapy for the treatment of AHF.