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

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background The coronavirus, cause of COVID-19 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 drug FVP as a treatment for COVID-19. Methods Databases like Pubmed, Medline, Google Scholar, preprint sites, and clinicaltirals.gov were searched. Studies including FVP along with the standard of care (SOC) were taken in the treatment arm and SOC including other antivirals, and supportive care as control arm. Quantitative synthesis done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirement were studied. Results We identified a total of 824 studies after electronic database searching. Five in qualitative studies and three studies in quantitative synthesis meet the criteria. There was a significant clinical improvement on FVP arms on 14th day compared to control arms (RR 1.41, 1.10–1.80). Clinical deterioration rates was significantly unlikely in FVP group (OR 0.21, 0.08–0.58) at the endpoint of study. The meta-analysis showed no significant differences between two arms on virological clearance (Day 14: RR 1.03, 0.64–1.67), oxygen requirement (OR 0.47, 0.21–1.04), and adverse effects (OR 0.42, 0.03–6.05). There are 25 Randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment. Conclusion There is significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on virological clearance, oxygen support requirement and side effect profile.</jats:p>

The efficacy and safety of Favipiravir in treatment of COVID-19: A systematic review and meta-analysis of clinical trials

“…However, this difference was not statistically significant after seven and ten days, which could be related to inappropriate dose and duration of treatment with favipiravir 41 . In another meta-analysis by Shrestha et al, it was stated that viral clearance on seventh and 14 th was not significant between the favipiravir and control groups 40 .…”

“…The obtained results demonstrated the clinical improvement after seven and 14 days of hospitalization was more remarkable in patients taking favipiravir than those receiving other drugs. Another meta-analysis conducted by Shrestha et al demonstrated that clinical improvement was observed on both the seventh and 14 th day of treatment 40 . Udwadia et al reported the time of clinical improvement was significantly faster in patients in the favipiravir group than those who are not 39 .…”

SARS-CoV-2: Targeted managements and vaccine development

“…Favipiravir was approved for the treatment of SARS-CoV-2 in Russia and India and currently assessed in many countries. The drug is given orally and improves the patients’ conditions in the clinic compared to the standard of care but no significant difference in viral clearance, the requirement for oxygen support, and side effect profile [ 102 ]. In an open-label clinical trial (ChiCTR2000029600), COVID-19 patients were treated with favipiravir (1600 mg twice daily on Day 1 and 600 mg twice daily on days 2 to 14, orally) or lopinavir-ritonavir (400 mg/100 mg twice daily orally).…”

Therapeutic strategies to fight COVID-19: which is the status artis?

“…Based on these preliminary results, the Russian Ministry of Health granted, in May 2020, a fast-track marketing authorization to favipiravir for the treatment of COVID-19 patients. A meta-analysis of some aforementioned clinical trials showed a significant clinical and radiological improvement with favipiravir compared to the standard of care, but no significant difference with regards to viral clearance, oxygen support requirement, or side effects (Shrestha et al, 2020). Currently, two clinical trials are ongoing to evaluate the efficacy and safety of favipiravir alone (NCT04336904) or in combination with tocilizumab (NCT04310228) for the treatment of COVID-19.…”