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Favipiravir in Hospitalized COVID-19 Patients: A Meta-Analysis of Randomized Controlled Trials

Monday, January 22, 2024
10:55 AM – 11:05 AM MT
Location: Connections Central - Star Research Theater
Introduction: COVID-19 remains a significant burden on the healthcare community. Favipiravir, an RNA-dependent RNA polymerase inhibitor, is being investigated for COVID-19 as a promising therapeutic option. However, the data on its effectiveness in patients hospitalized with COVID-19 is scarce. Hence, we sought to investigate the efficacy and safety of favipiravir in hospitalized COVID-19 patients.


Methods: We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to June 2023 to retrieve all randomized controlled trials (RCTs) evaluating the use of favipiravir as compared to placebo or standard treatment in hospitalized COVID-19 patients. Our primary outcome was all-cause mortality, and our secondary outcomes were the risk of ICU admission, incidence of mechanical ventilation (MV), rate of no recovery, adverse events (AEs), and serious adverse events (SAEs). We used RevMan 5.4 to pool data using risk ratios and 95% confidence intervals (CIs) under a random-effects model.


Results: We included a total of 13 RCTs in our review. There was no significant difference in the risk of all-cause mortality (RR 0.98, 95% CI 0.66, 1.44; I2=0%), risk of ICU admission (RR 0.85, 95% CI 0.69, 1.05; I2=0%), and the incidence of MV (RR 1.01, 95% CI 0.75, 1.38; I2=0%) between the favipiravir and control groups. There was a significant decrease in the rate of no recovery in the favipiravir group as compared to the control group (RR 0.77, 95% CI 0.63, 0.93; I2=48%). Favipiravir increased the risk of AEs (RR 1.33 95% CI 1.17, 1.51; I2=74%) but the incidence of SAEs was similar between the two groups (RR 1.13, 95% CI 0.78, 1.65; I2=0%).


Conclusions: Favipiravir has no effect on mortality, MV, and ICU admission but it improves recovery in hospitalized COVID-19 patients albeit with an increased risk of adverse events. However, our analysis is limited by the small sample sizes of included RCTs. Large-scale trials are required to further substantiate its efficacy and safety.