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Favipiravir for COVID-19: real-time meta analysis of 40 studies
Covid Analysis, May 21, 2022, DRAFT
https://c19favipiravir.com/meta.html
0 0.5 1 1.5+ All studies 23% 40 17,123 Improvement, Studies, Patients Relative Risk Mortality 8% 21 13,597 Ventilation 14% 6 9,313 ICU admission -28% 14 2,986 Hospitalization 1% 10 1,495 Progression 47% 5 8,239 Recovery 16% 17 3,566 Viral clearance 30% 19 3,921 RCTs 22% 22 3,431 Peer-reviewed 27% 35 15,522 Early 29% 9 9,302 Late 21% 31 7,821 Favipiravir for COVID-19 c19favipiravir.com May 2022 Favorsfavipiravir Favorscontrol after exclusions
Statistically significant improvements are seen for progression, recovery, and viral clearance. 20 studies from 20 independent teams in 14 different countries show statistically significant improvements in isolation (10 for the most serious outcome).
Meta analysis using the most serious outcome reported shows 23% [11‑34%] improvement. Results are similar for Randomized Controlled Trials, similar after exclusions, and similar for peer-reviewed studies.
0 0.5 1 1.5+ All studies 23% 40 17,123 Improvement, Studies, Patients Relative Risk Mortality 8% 21 13,597 Ventilation 14% 6 9,313 ICU admission -28% 14 2,986 Hospitalization 1% 10 1,495 Progression 47% 5 8,239 Recovery 16% 17 3,566 Viral clearance 30% 19 3,921 RCTs 22% 22 3,431 Peer-reviewed 27% 35 15,522 Early 29% 9 9,302 Late 21% 31 7,821 Favipiravir for COVID-19 c19favipiravir.com May 2022 Favorsfavipiravir Favorscontrol after exclusions
Studies to date do not show a significant benefit for mortality. Potential risks of the mechanism of action include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity [Hadj Hassine, Waters, Zhirnov].
While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 5% of favipiravir studies show zero events in the treatment arm. Multiple treatments are typically used in combination, and other treatments are more effective.
No treatment, vaccine, or intervention is 100% available and effective for all variants. All practical, effective, and safe means should be used. Denying the efficacy of treatments increases mortality, morbidity, collateral damage, and endemic risk.
All data to reproduce this paper and sources are in the appendix. Other meta analyses for favipiravir can be found in [Hung, Lan], showing significant improvements for viral clearance, improvement, and hospital discharge.
Highlights
Favipiravir reduces risk for COVID-19 with very high confidence for viral clearance and in pooled analysis, and high confidence for progression and recovery, however increased risk is seen with very high confidence for ICU admission. Potential risks include the creation of dangerous variants, carcinogenicity, and genotoxicity.
We show traditional outcome specific analyses and combined evidence from all studies, incorporating treatment delay, a primary confounding factor in COVID-19 studies.
Real-time updates and corrections, transparent analysis with all results in the same format, consistent protocol for 42 treatments.
A
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 6% 0.94 [0.78-1.14] hosp. 3/112 2/56 Improvement, RR [CI] Treatment Control Udwadia (RCT) 40% 0.60 [0.38-0.95] recov. time 75 (n) 75 (n) Sawanpanyalert 68% 0.32 [0.15-0.66] progression n/a n/a Holubar (DB RCT) 89% 0.11 [0.01-2.02] hosp. 0/75 4/74 Alattar (PSM) 33% 0.67 [0.28-1.61] death 8/387 12/387 Bosaeed (DB RCT) -619% 7.19 [0.38-138] ICU 3/112 0/119 Lowe (DB RCT) -196% 2.96 [0.12-71.1] ICU 1/54 0/52 Adhikari (RCT) -40% 1.40 [0.57-3.44] no improv. 10/38 6/32 Tsuzuki 13% 0.87 [0.52-1.46] death 2,532 (n) 5,122 (n) Tau​2 = 0.11, I​2 = 35.9%, p = 0.092 Early treatment 29% 0.71 [0.48-1.06] 25/3,385 24/5,917 29% improvement Cai 69% 0.31 [0.10-0.96] pneumonia 35 (n) 45 (n) Improvement, RR [CI] Treatment Control Ivashchenko (RCT) 46% 0.54 [0.33-0.88] viral+ 15/40 14/20 Lou (RCT) -422% 5.22 [0.28-96.2] ICU 2/9 0/10 Pushkar (RCT) 14% 0.86 [0.74-0.99] no recov. 73/100 85/100 Khamis (RCT) 15% 0.85 [0.28-2.59] death 5/44 6/45 OT​1 CT​2 Solaymani.. (RCT) -19% 1.19 [0.70-2.04] death 26/190 21/183 OT​1 Zhao (RCT) 59% 0.41 [0.18-0.93] viral+ 7/36 9/19 Aghajani 26% 0.74 [0.43-1.27] death 40 (n) 951 (n) Alamer -56% 1.56 [0.73-3.36] death 12/233 21/223 Almoosa -42% 1.42 [0.90-2.25] death 33/110 24/116 Shinkai (SB RCT) 37% 0.63 [0.40-0.98] imp. time 107 (n) 49 (n) Assiri (ICU) -79% 1.79 [0.33-8.02] death 11/67 3/51 ICU patients Kulzhanova 88% 0.12 [0.04-0.37] no improv. 3/40 25/40 Chen (RCT) -3% 1.03 [0.15-7.22] ICU 2/116 2/120 OT​1 Alotaibi 57% 0.43 [0.18-1.01] death 244 (n) 193 (n) OT​1 Tabarsi (RCT) 30% 0.70 [0.17-2.88] death 3/32 4/30 OT​1 Atipornwa.. (RCT) 23% 0.77 [0.35-1.67] death 10/100 13/100 OT​1 CT​2 Damayanti 54% 0.46 [0.22-0.92] no recov. 96 (n) 96 (n) Shenoy (DB RCT) -29% 1.29 [0.60-2.77] death 14/175 11/178 Chuah (RCT) -1154% 12.54 [0.76-208] death 5/250 0/250 Finberg (RCT) -200% 3.00 [0.13-70.3] death 1/25 0/25 Al Mutair (ICU) 7% 0.93 [0.77-1.12] death 119/269 128/269 ICU patients OT​1 Kurniyanto 48% 0.52 [0.22-1.25] death 10/325 9/152 Cilli 38% 0.62 [0.24-1.63] death 5/23 8/23 Yulia 85% 0.15 [0.02-1.02] death n/a n/a Uyaroğlu (PSM) 67% 0.33 [0.01-7.96] death 0/42 1/42 OT​1 AlQahtani (RCT) -196% 2.96 [0.12-71.1] death 1/54 0/52 Shinada 7% 0.93 [0.45-1.89] hosp. 17 (n) 17 (n) Hassaniazad (RCT) 68% 0.32 [0.07-1.48] death 2/32 6/31 OT​1 Hafez -3% 1.03 [0.68-1.56] viral+ 59 (n) 1,446 (n) CT​2 Rahman (DB RCT) 89% 0.11 [0.01-0.75] no improv. 1/19 8/16 Tau​2 = 0.06, I​2 = 61.6%, p = 0.0033 Late treatment 21% 0.79 [0.67-0.92] 360/2,929 398/4,892 21% improvement All studies 23% 0.77 [0.66-0.89] 385/6,314 422/10,809 23% improvement 40 favipiravir COVID-19 studies c19favipiravir.com May 2022 Tau​2 = 0.06, I​2 = 60.1%, p = 0.00053 Effect extraction pre-specified(most serious outcome, see appendix) 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 1. A. Random effects meta-analysis. This plot shows pooled effects, discussion can be found in the heterogeneity section, and results for specific outcomes can be found in the individual outcome analyses. Effect extraction is pre-specified, using the most serious outcome reported. For details of effect extraction see the appendix. B. Scatter plot showing the distribution of effects reported in studies. C. History of all reported effects (chronological within treatment stages).
Introduction
We analyze all significant studies concerning the use of favipiravir for COVID-19. Search methods, inclusion criteria, effect extraction criteria (more serious outcomes have priority), all individual study data, PRISMA answers, and statistical methods are detailed in Appendix 1. We present random effects meta-analysis results for all studies, for studies within each treatment stage, for individual outcomes, for peer-reviewed studies, for Randomized Controlled Trials (RCTs), and after exclusions.
Figure 2 shows stages of possible treatment for COVID-19. Prophylaxis refers to regularly taking medication before becoming sick, in order to prevent or minimize infection. Early Treatment refers to treatment immediately or soon after symptoms appear, while Late Treatment refers to more delayed treatment.
Figure 2. Treatment stages.
Preclinical Research
An In Vitro study supports the efficacy of favipiravir [Unal].
Preclinical research is an important part of the development of treatments, however results may be very different in clinical trials. Preclinical results are not used in this paper.
Results
Figure 3 shows a visual overview of the results, with details in Table 1 and Table 2. Figure 4, 5, 6, 7, 8, 9, 10, 11, and 12 show forest plots for a random effects meta-analysis of all studies with pooled effects, mortality results, ventilation, ICU admission, hospitalization, progression, recovery, viral clearance, and peer reviewed studies.
0 0.5 1 1.5+ ALL STUDIES MORTALITY VENTILATION ICU ADMISSION HOSPITALIZATION PROGRESSION RECOVERY VIRAL CLEARANCE RCTS PEER-REVIEWED After Exclusions ALL STUDIES All Early Late Favipiravir for COVID-19 C19FAVIPIRAVIR.COM MAY 2022
Figure 3. Overview of results.
Treatment timeNumber of studies reporting positive effects Total number of studiesPercentage of studies reporting positive effects Random effects meta-analysis results
Early treatment 6 9 66.7% 29% improvement
RR 0.71 [0.48‑1.06]
p = 0.092
Late treatment 20 31 64.5% 21% improvement
RR 0.79 [0.67‑0.92]
p = 0.0033
All studies 26 40 65.0% 23% improvement
RR 0.77 [0.66‑0.89]
p = 0.00053
Table 1. Results by treatment stage.
Studies Early treatment Late treatment PatientsAuthors
All studies 4029% [-6‑52%]21% [8‑33%] 17,123 628
With exclusions 3529% [-6‑52%]19% [4‑32%] 16,201 585
Peer-reviewed 3531% [-18‑59%]25% [10‑38%] 15,522 545
Randomized Controlled TrialsRCTs 2210% [-78‑55%]23% [2‑40%] 3,431 406
Table 2. Results by treatment stage for all studies and with different exclusions.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 6% 0.94 [0.78-1.14] hosp. 3/112 2/56 Improvement, RR [CI] Treatment Control Udwadia (RCT) 40% 0.60 [0.38-0.95] recov. time 75 (n) 75 (n) Sawanpanyalert 68% 0.32 [0.15-0.66] progression n/a n/a Holubar (DB RCT) 89% 0.11 [0.01-2.02] hosp. 0/75 4/74 Alattar (PSM) 33% 0.67 [0.28-1.61] death 8/387 12/387 Bosaeed (DB RCT) -619% 7.19 [0.38-138] ICU 3/112 0/119 Lowe (DB RCT) -196% 2.96 [0.12-71.1] ICU 1/54 0/52 Adhikari (RCT) -40% 1.40 [0.57-3.44] no improv. 10/38 6/32 Tsuzuki 13% 0.87 [0.52-1.46] death 2,532 (n) 5,122 (n) Tau​2 = 0.11, I​2 = 35.9%, p = 0.092 Early treatment 29% 0.71 [0.48-1.06] 25/3,385 24/5,917 29% improvement Cai 69% 0.31 [0.10-0.96] pneumonia 35 (n) 45 (n) Improvement, RR [CI] Treatment Control Ivashchenko (RCT) 46% 0.54 [0.33-0.88] viral+ 15/40 14/20 Lou (RCT) -422% 5.22 [0.28-96.2] ICU 2/9 0/10 Pushkar (RCT) 14% 0.86 [0.74-0.99] no recov. 73/100 85/100 Khamis (RCT) 15% 0.85 [0.28-2.59] death 5/44 6/45 OT​1 CT​2 Solaymani.. (RCT) -19% 1.19 [0.70-2.04] death 26/190 21/183 OT​1 Zhao (RCT) 59% 0.41 [0.18-0.93] viral+ 7/36 9/19 Aghajani 26% 0.74 [0.43-1.27] death 40 (n) 951 (n) Alamer -56% 1.56 [0.73-3.36] death 12/233 21/223 Almoosa -42% 1.42 [0.90-2.25] death 33/110 24/116 Shinkai (SB RCT) 37% 0.63 [0.40-0.98] imp. time 107 (n) 49 (n) Assiri (ICU) -79% 1.79 [0.33-8.02] death 11/67 3/51 ICU patients Kulzhanova 88% 0.12 [0.04-0.37] no improv. 3/40 25/40 Chen (RCT) -3% 1.03 [0.15-7.22] ICU 2/116 2/120 OT​1 Alotaibi 57% 0.43 [0.18-1.01] death 244 (n) 193 (n) OT​1 Tabarsi (RCT) 30% 0.70 [0.17-2.88] death 3/32 4/30 OT​1 Atipornwa.. (RCT) 23% 0.77 [0.35-1.67] death 10/100 13/100 OT​1 CT​2 Damayanti 54% 0.46 [0.22-0.92] no recov. 96 (n) 96 (n) Shenoy (DB RCT) -29% 1.29 [0.60-2.77] death 14/175 11/178 Chuah (RCT) -1154% 12.54 [0.76-208] death 5/250 0/250 Finberg (RCT) -200% 3.00 [0.13-70.3] death 1/25 0/25 Al Mutair (ICU) 7% 0.93 [0.77-1.12] death 119/269 128/269 ICU patients OT​1 Kurniyanto 48% 0.52 [0.22-1.25] death 10/325 9/152 Cilli 38% 0.62 [0.24-1.63] death 5/23 8/23 Yulia 85% 0.15 [0.02-1.02] death n/a n/a Uyaroğlu (PSM) 67% 0.33 [0.01-7.96] death 0/42 1/42 OT​1 AlQahtani (RCT) -196% 2.96 [0.12-71.1] death 1/54 0/52 Shinada 7% 0.93 [0.45-1.89] hosp. 17 (n) 17 (n) Hassaniazad (RCT) 68% 0.32 [0.07-1.48] death 2/32 6/31 OT​1 Hafez -3% 1.03 [0.68-1.56] viral+ 59 (n) 1,446 (n) CT​2 Rahman (DB RCT) 89% 0.11 [0.01-0.75] no improv. 1/19 8/16 Tau​2 = 0.06, I​2 = 61.6%, p = 0.0033 Late treatment 21% 0.79 [0.67-0.92] 360/2,929 398/4,892 21% improvement All studies 23% 0.77 [0.66-0.89] 385/6,314 422/10,809 23% improvement 40 favipiravir COVID-19 studies c19favipiravir.com May 2022 Tau​2 = 0.06, I​2 = 60.1%, p = 0.00053 Effect extraction pre-specified(most serious outcome, see appendix) 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 4. Random effects meta-analysis for all studies with pooled effects. This plot shows pooled effects, discussion can be found in the heterogeneity section, and results for specific outcomes can be found in the individual outcome analyses. Effect extraction is pre-specified, using the most serious outcome reported. For details of effect extraction see the appendix.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Alattar (PSM) 33% 0.67 [0.28-1.61] 8/387 12/387 Improvement, RR [CI] Treatment Control Tsuzuki 13% 0.87 [0.52-1.46] 2,532 (n) 5,122 (n) Tau​2 = 0.00, I​2 = 0.0%, p = 0.36 Early treatment 19% 0.81 [0.53-1.26] 8/2,919 12/5,509 19% improvement Khamis (RCT) 15% 0.85 [0.28-2.59] 5/44 6/45 OT​1 CT​2 Improvement, RR [CI] Treatment Control Solaymani.. (RCT) -19% 1.19 [0.70-2.04] 26/190 21/183 OT​1 Aghajani 26% 0.74 [0.43-1.27] 40 (n) 951 (n) Alamer -56% 1.56 [0.73-3.36] 12/233 21/223 Almoosa -42% 1.42 [0.90-2.25] 33/110 24/116 Assiri (ICU) -79% 1.79 [0.33-8.02] 11/67 3/51 ICU patients Alotaibi 57% 0.43 [0.18-1.01] 244 (n) 193 (n) OT​1 Tabarsi (RCT) 30% 0.70 [0.17-2.88] 3/32 4/30 OT​1 Atipornwa.. (RCT) 23% 0.77 [0.35-1.67] 10/100 13/100 OT​1 CT​2 Shenoy (DB RCT) -29% 1.29 [0.60-2.77] 14/175 11/178 Chuah (RCT) -1154% 12.54 [0.76-208] 5/250 0/250 Finberg (RCT) -200% 3.00 [0.13-70.3] 1/25 0/25 Al Mutair (ICU) 7% 0.93 [0.77-1.12] 119/269 128/269 ICU patients OT​1 Kurniyanto 48% 0.52 [0.22-1.25] 10/325 9/152 Cilli 38% 0.62 [0.24-1.63] 5/23 8/23 Yulia 85% 0.15 [0.02-1.02] n/a n/a Uyaroğlu (PSM) 67% 0.33 [0.01-7.96] 0/42 1/42 OT​1 AlQahtani (RCT) -196% 2.96 [0.12-71.1] 1/54 0/52 Hassaniazad (RCT) 68% 0.32 [0.07-1.48] 2/32 6/31 OT​1 Tau​2 = 0.05, I​2 = 26.9%, p = 0.53 Late treatment 7% 0.93 [0.75-1.16] 257/2,255 255/2,914 7% improvement All studies 8% 0.92 [0.76-1.11] 265/5,174 267/8,423 8% improvement 21 favipiravir COVID-19 mortality results c19favipiravir.com May 2022 Tau​2 = 0.03, I​2 = 21.0%, p = 0.38 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 5. Random effects meta-analysis for mortality results.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Tsuzuki -2% 1.02 [0.65-1.60] 2,532 (n) 5,122 (n) Improvement, RR [CI] Treatment Control Tau​2 = 0.00, I​2 = 0.0%, p = 0.93 Early treatment -2% 1.02 [0.65-1.60] 0/2,532 0/5,122 -2% improvement Solaymani.. (RCT) -53% 1.53 [0.86-2.71] 27/190 17/183 OT​1 Improvement, RR [CI] Treatment Control Alamer 90% 0.10 [0.04-0.29] 4/218 27/165 Shenoy (DB RCT) -33% 1.33 [0.67-2.66] 17/175 13/178 Chuah (RCT) -20% 1.20 [0.36-3.97] 6/250 5/250 Finberg (RCT) -200% 3.00 [0.13-70.3] 1/25 0/25 Tau​2 = 1.02, I​2 = 82.2%, p = 0.72 Late treatment 18% 0.82 [0.29-2.32] 55/858 62/801 18% improvement All studies 14% 0.86 [0.43-1.73] 55/3,390 62/5,923 14% improvement 6 favipiravir COVID-19 mechanical ventilation results c19favipiravir.com May 2022 Tau​2 = 0.50, I​2 = 77.8%, p = 0.69 1 OT: comparison with other treatment Favors favipiravir Favors control
Figure 6. Random effects meta-analysis for ventilation.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Bosaeed (DB RCT) -619% 7.19 [0.38-138] 3/112 0/119 Improvement, RR [CI] Treatment Control Lowe (DB RCT) -196% 2.96 [0.12-71.1] 1/54 0/52 Tau​2 = 0.00, I​2 = 0.0%, p = 0.16 Early treatment -377% 4.77 [0.55-41.5] 4/166 0/171 -377% improvement Lou (RCT) -422% 5.22 [0.28-96.2] 2/9 0/10 Improvement, RR [CI] Treatment Control Khamis (RCT) -2% 1.02 [0.42-2.48] 8/44 8/45 OT​1 CT​2 Solaymani.. (RCT) -19% 1.19 [0.73-1.94] 31/190 25/183 OT​1 Almoosa -90% 1.90 [1.11-3.26] 110 (n) 116 (n) Chen (RCT) -3% 1.03 [0.15-7.22] 2/116 2/120 OT​1 Tabarsi (RCT) 41% 0.59 [0.22-1.59] 5/32 8/30 OT​1 Shenoy (DB RCT) -2% 1.02 [0.57-1.82] 20/175 20/178 Chuah (RCT) -9% 1.09 [0.49-2.31] 13/250 12/250 Al Mutair (ICU) -34% 1.34 [1.13-1.59] 269 (n) 269 (n) ICU patients OT​1 Uyaroğlu (PSM) -200% 3.00 [0.13-71.6] 1/42 0/42 OT​1 AlQahtani (RCT) 76% 0.24 [0.03-2.08] 1/54 4/52 Hassaniazad (RCT) 35% 0.65 [0.20-2.07] 4/32 6/31 OT​1 Tau​2 = 0.00, I​2 = 0.0%, p = 0.00081 Late treatment -28% 1.28 [1.11-1.47] 87/1,323 85/1,326 -28% improvement All studies -28% 1.28 [1.11-1.48] 91/1,489 85/1,497 -28% improvement 14 favipiravir COVID-19 ICU results c19favipiravir.com May 2022 Tau​2 = 0.00, I​2 = 0.0%, p = 0.0006 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 7. Random effects meta-analysis for ICU admission.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 6% 0.94 [0.78-1.14] hosp. 3/112 2/56 Improvement, RR [CI] Treatment Control Holubar (DB RCT) 89% 0.11 [0.01-2.02] hosp. 0/75 4/74 Bosaeed (DB RCT) -219% 3.19 [0.66-15.5] hosp. 6/112 2/119 Lowe (DB RCT) -196% 2.96 [0.12-71.1] hosp. 1/54 0/52 Tau​2 = 0.57, I​2 = 31.6%, p = 0.78 Early treatment -22% 1.22 [0.33-4.56] 10/353 8/301 -22% improvement Ivashchenko (RCT) -300% 4.00 [0.20-79.6] hosp. 2/40 0/20 Improvement, RR [CI] Treatment Control Tabarsi (RCT) 25% 0.75 [0.58-0.97] hosp. time 32 (n) 30 (n) OT​1 Al Mutair (ICU) -37% 1.37 [1.14-1.64] hosp. time 269 (n) 269 (n) ICU patients OT​1 Uyaroğlu (PSM) -11% 1.11 [0.24-5.08] hosp. time 42 (n) 42 (n) OT​1 Shinada 7% 0.93 [0.45-1.89] hosp. 17 (n) 17 (n) Hassaniazad (RCT) 25% 0.75 [0.51-1.10] hosp. time 32 (n) 31 (n) OT​1 Tau​2 = 0.11, I​2 = 72.3%, p = 0.83 Late treatment 4% 0.96 [0.67-1.37] 2/432 0/409 4% improvement All studies 1% 0.99 [0.70-1.39] 12/785 8/710 1% improvement 10 favipiravir COVID-19 hospitalization results c19favipiravir.com May 2022 Tau​2 = 0.11, I​2 = 60.3%, p = 0.96 1 OT: comparison with other treatment Favors favipiravir Favors control
Figure 8. Random effects meta-analysis for hospitalization.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Sawanpanyalert 68% 0.32 [0.15-0.66] n/a n/a Improvement, RR [CI] Treatment Control Holubar (DB RCT) 30% 0.70 [0.23-2.12] 5/75 7/74 Tsuzuki 18% 0.82 [0.66-1.04] 2,532 (n) 5,122 (n) Tau​2 = 0.20, I​2 = 64.4%, p = 0.11 Early treatment 40% 0.60 [0.32-1.13] 5/2,607 7/5,196 40% improvement Chen (RCT) 74% 0.26 [0.03-2.28] 1/116 4/120 OT​1 Improvement, RR [CI] Treatment Control Atipornwa.. (RCT) 60% 0.40 [0.20-0.79] 10/100 25/100 OT​1 CT​2 Tau​2 = 0.00, I​2 = 0.0%, p = 0.0039 Late treatment 62% 0.38 [0.20-0.74] 11/216 29/220 62% improvement All studies 47% 0.53 [0.32-0.88] 16/2,823 36/5,416 47% improvement 5 favipiravir COVID-19 progression results c19favipiravir.com May 2022 Tau​2 = 0.17, I​2 = 58.2%, p = 0.014 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 9. Random effects meta-analysis for progression.
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 39% 0.61 [0.43-0.88] no recov. 112 (n) 56 (n) Improvement, RR [CI] Treatment Control Udwadia (RCT) 40% 0.60 [0.38-0.95] recov. time 75 (n) 75 (n) Holubar (DB RCT) -19% 1.19 [0.78-1.85] no recov. 65 (n) 70 (n) Alattar (PSM) -2% 1.02 [0.90-1.16] no recov. 26/387 28/387 Bosaeed (DB RCT) -12% 1.12 [0.80-1.56] no recov. 112 (n) 119 (n) Tau​2 = 0.07, I​2 = 63.5%, p = 0.38 Early treatment 13% 0.87 [0.64-1.18] 26/751 28/707 13% improvement Ivashchenko (RCT) -67% 1.67 [0.52-5.39] no disch. 10/40 3/20 Improvement, RR [CI] Treatment Control Pushkar (RCT) 14% 0.86 [0.74-0.99] no recov. 73/100 85/100 Khamis (RCT) -10% 1.10 [0.60-1.99] no recov. 15/44 14/45 OT​1 CT​2 Alamer 49% 0.51 [0.41-0.64] no disch. 221 (n) 201 (n) Almoosa -11% 1.11 [0.96-1.29] recov. time 110 (n) 116 (n) Shinkai (SB RCT) 37% 0.63 [0.40-0.98] imp. time 107 (n) 49 (n) Chen (RCT) 20% 0.80 [0.60-1.08] no recov. 45/116 58/120 OT​1 Tabarsi (RCT) 6% 0.94 [0.72-1.23] CT imp. 24/32 24/30 OT​1 Damayanti 54% 0.46 [0.22-0.92] no recov. 96 (n) 96 (n) Shenoy (DB RCT) -1% 1.01 [0.78-1.30] no recov. 157 (n) 158 (n) Finberg (RCT) 58% 0.42 [0.16-1.10] no recov. 25 (n) 25 (n) AlQahtani (RCT) -42% 1.42 [0.50-4.04] no recov. 8/53 5/47 Tau​2 = 0.06, I​2 = 75.3%, p = 0.039 Late treatment 18% 0.82 [0.68-0.99] 175/1,101 189/1,007 18% improvement All studies 16% 0.84 [0.72-0.97] 201/1,852 217/1,714 16% improvement 17 favipiravir COVID-19 recovery results c19favipiravir.com May 2022 Tau​2 = 0.06, I​2 = 71.2%, p = 0.022 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
Figure 10. Random effects meta-analysis for recovery.