Systematic review and meta-analysis of effectiveness and safety of favipiravir in the management of novel coronavirus (COVID-19) patients

Prakash, Ajay; Singh, Harvinder; Kaur, Hardeep; Semwal, Ankita; Sarma, Phulen; Bhattacharyya, Anusuya; Dhibar, Deba Prasad; Medhi, Bikash

Multiple options are being tried for the management of 2019-nCoV infection since its pandemic started. Favipiravir (FPV) is one of drugs, which is also being tried for the management of 2019-nCoV infection. The present study aimed to evaluate the efficacy and safety of FPV in published literature. Comparative randomized or nonrandomized controlled clinical trials comparing FPV to the standard of care (SOC)/control or other antiviral agent/combinations were included. A total of 12 databases were searched and identify four studies which were further used for final analysis. The data analysis was done as pooled prevalence using a random effect model by “RevMan manager version 5.4.1 and “R” software. The point estimate, odds ratio (OR) with 95% confidence interval (CI) was calculated for dichotomous data. In the present study, the marginal beneficial effect was seen in the FPV group in overall clinical improvement comparison to SOC/control, i.e., (4 studies, log OR [95% CI] (−0.19 [−0.51, 0.13]). However, in all other outcomes, it was found to be comparable to the SOC/control arm namely “clinical improvement on day 7–10” (3 studies, OR [95% CI] 1.63 [1.07, 2.48]) while “clinical improvement on day 10–14” (3 studies, OR [95% CI] 1.37 [0.24, 7.82]) and viral negativity was seen (4 studies, OR [95% CI] 1.91 [0.91, 4.01]). No difference in efficacy was found between FPV versus lopinavir/ritonavir or arbidol groups. Regarding adverse effects, except for the occurrence of rash (higher in the FPV group), safety was comparable to SOC. In our study, there was a marginal difference between the FPV and the SOC arm in terms of “clinical improvement” on day 7–10 or 10–14, and “virological negativity” on day 10–14.” However, some benefit was observed in a few studies, but it was also comparable to the control drugs or SOC.