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

Abstract 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.