Sagar Panchal 1, K. Venugopal2, Agam Vora3, Anil Daxini4, Pramod Dadhich5, Sagar Bhagat1, Saiprasad Patil1, Hanmant Barkate1 1Global Medical Affairs, Glenmark pharmaceuticals Ltd, India, 2Sooriya Hospital, India, 3Vora Clinic, India, 4Fortis Hospital, India, 5Dadhich Clinic, India Background & Aims: Higher age (>50 yrs.) and comorbidity associations are proven risk factors for rapid progression and mortality in COVID‐19. We planned to analyse benefit of favipiravir in high risk COVID‐19 patients in real world setting. Methods: Retrospective cohort study was conducted in favipiravir treated high risk (age >50 years and ≥1 comorbidity) COVID‐19 patients at 4 Indian centres after ethics committee approval. Medical records from Oct 2020 ‐ Feb 2021 were analyzed to capture required details. Results: Of 358 favipiravir treated patients, 154 had age >50 years and ≥1 comorbidity. Average age was 52.4±16.4 yrs. and M:F ratio of 1.3:1. HTN(74.5%) and DM(66.9%) were most common comorbidities. At baseline, mean SpO2 and respiratory rate was 95.6±3.2 and 22.1±10.9.106 (68.8%) and 48 (31.2%) had mild and moderate severity illness respectively. Most common symptoms were fever (87%), myalgia (79.2%), cough (63%), fatigue (41.6) and myalgia (37.7%). Median duration of favipiravir treatment was 14d (2‐14d). 22.7% received concomitant steroids. Rate of clinical resolution of symptoms at D5, D7, D10 were 74%, 85.7% and 94.8% respectively. Fever resolved in 89.6%, 97.4% and 99.4% patients by D5, D7, D10 respectively. Requirement of respiratory support reduced from 28.6% at baseline to 3.9% by D7. Progression of disease was observed in 10(6.5%) with mortality in 3 patients. TEAEs were observed in 12(8.4%), with diarrhoea being commonest (3.9%). Conclusion: We observed trend of early clinical resolution & limited disease progression with favipiravir in high risk COVID‐19 patients. Our findings need to be evaluated in bigger and controlled clinical trial settings.