Commentary: Combination Treatment Using Favipiravir for Crimean-Congo Hemorrhagic Fever

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Crimean-Congo hemorrhagic fever virus is a tick-borne bunyavirus that causes Crimean-Congo hemorrhagic fever, characterized by acute febrile illness and rapid progress to severe hemorrhage manifestations with a high mortality rate. No specific antiviral drugs have been approved for the treatment of Crimean-Congo hemorrhagic fever. Favipiravir, a broad-spectrum antiviral drug originally developed for influenza, is known to inhibit the activity of RNA-dependent RNA polymerase of various RNA viruses. Recently, favipiravir demonstrated in vivo efficacy against Crimean-Congo hemorrhagic fever virus in animal models. For the purpose of promptly finding effective drugs for Crimean-Congo hemorrhagic fever, drug repurposing has been proposed. Especially, computational screening through in silico studies offer a cost-effective and time-efficient approach to identifying potential drug candidates for repurposing. This approach demonstrated that tetracycline and the phytochemical skullcapflavone I, are efficacious against Crimean-Congo hemorrhagic fever virus. Scutellaria, which contains skullcapflavone I in its extracts, is a component of the Kampo medicines Sho-saiko-to and Saiko-keishi-to. In the near future, the aforementioned drugs may be recognized as Crimean-Congo hemorrhagic fever virus inhibitors. Furthermore, considering the synergistic effects of drugs, a combination of favipiravir and tetracycline, or a combination of favipiravir and Kampo medicine may be more effective.