Favipiravir versus other antiviral or standard of care for COVID-19 treatment: a rapid systematic review and meta-analysis

Abstract

Background The COVID-19 causing coronavirus is an enveloped RNA virus that utilizes an enzyme RNA dependent RNA polymerase for its replication. Favipiravir (FVP) triphosphate, a purine nucleoside analog, inhibits that enzyme. We have conducted this systematic review and meta-analysis on efficacy and safety of the drug FVP as a treatment for COVID-19. Methods Databases like Pubmed, Pubmed Central, Scopus, Embase, Google Scholar, preprint sites, and clinicaltirals.gov were searched. The studies with the standard of care (SOC) and FVP as a treatment drug were considered as the treatment group and the SOC with other antivirals and supportive care as the control group. Quantitative synthesis was done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirements were studied. Results We identified a total of 1798 studies after searching the electronic databases. Nine in the qualitative studies and four studies in the quantitative synthesis met the criteria. There was a significant clinical improvement in the FVP group on the 14th day compared to the control group (RR 1.29, 1.08–1.54). Clinical deterioration rates were less likely in the FVP group though statistically not significant (OR 0.59, 95% CI 0.30–1.14) at the endpoint of study (7–15 days). The meta-analysis showed no significant differences between the two groups on viral clearance (day 14: RR 1.06, 95% CI 0.84–1.33), non-invasive ventilation or oxygen requirement (OR 0.76, 95% CI 0.42–1.39), and adverse effects (OR 0.69, 0.13–3.57). There are 31 randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment. Conclusion There is a significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on viral clearance, oxygen support requirement and side effect profiles.

Remdesivir: A potential game-changer or just a myth? A systematic review and meta-analysis

“…Many other drugs were repurposed like remdesivir as candidate treatment options for COVID-19. A study was done by Shrestha et al on favipiravir - another potential candidate drug that showed significant results on clinical improvement at day 14 (RR 1.41, 95% CI 1.10 to 1.80) [ 24 ]. Many other potential treatment options like corticosteroids, convalescent plasma therapy, and hydroxy-chloroquine showed mixed results in individual studies.…”

Favipiravir in Therapy of Viral Infections

“…Despite the fact that the most of studies present very low-quality evidence, related to the small size of groups, the use of additional drugs, or incomplete assessment of the initial parameters of patients, the systematic review and meta-analysis carried out by Shrestha et al [ 65 ] showed a significant clinical and radiological improvement, following treatment with FVP in comparison to the standard of care, with no significant differences on viral clearance, oxygen support requirement, and side-effect profiles.…”

Extraordinary Survival Benefits of Severe and Critical Patients with COVID-19 by Immune Modulators: The Outcome of a Clinical Trial in Bangladesh

“…A meta-analysis of two groups was carried out: one receiving standard care plus favipiravir and the other receiving standard care plus other regimen indicating no specific treatment benefit of favipiravir. 27 Another meta-analysis with 76 articles using remdesivir revealed that further randomized controlled trials with larger sample sizes are required to identify the best candidate components that should comprise combined treatments for COVID-19. 28 …”