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26 favipiravir COVID-19 controlled studies,
16 RCTs
https://c19favipiravir.com/meta.html
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
All studies 28% 26
6,386
Improvement, Studies, Patients Relative Risk With exclusions 28% 23
5,987
Mortality -3% 13
4,629
Ventilation 18% 5
1,659
ICU admission -21% 8
2,070
Hospitalization 2% 5
670
Progression 60% 4
585
Recovery 19% 16
3,466
Viral clearance 33% 12
2,064
RCTs 23% 16
3,032
Peer-reviewed 31% 21
4,742
Early 45% 6
1,472
Late 24% 20
4,914
Favipiravir for COVID-19 c19favipiravir.com Jan 16, 2022
Favors favipiravir
Favors control
• Statistically significant improvements are seen for
progression ,
recovery , and
viral clearance . 17 studies from 17 independent teams in 12 different countries show statistically significant
improvements in isolation (9 for the most serious outcome).
• Overall mortality results are negative, however this is
dominated by late treatment studies. Early treatment shows positive
results for mortality, but with very limited data.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
All studies 28% 26
6,386
Improvement, Studies, Patients Relative Risk With exclusions 28% 23
5,987
Mortality -3% 13
4,629
Ventilation 18% 5
1,659
ICU admission -21% 8
2,070
Hospitalization 2% 5
670
Progression 60% 4
585
Recovery 19% 16
3,466
Viral clearance 33% 12
2,064
RCTs 23% 16
3,032
Peer-reviewed 31% 21
4,742
Early 45% 6
1,472
Late 24% 20
4,914
Favipiravir for COVID-19 c19favipiravir.com Jan 16, 2022
Favors favipiravir
Favors control
• While many treatments have some level
of efficacy, they do not replace vaccines and other measures to avoid
infection.
Only 4% of favipiravir
studies show zero events in the treatment arm.
• Multiple treatments are typically used
in combination, and
other treatments
are more effective.
• Elimination of COVID-19 is a race
against viral evolution. No treatment, vaccine, or intervention is 100%
available and effective for all variants. All practical, effective, and safe
means should be used, including treatments, as supported by Pfizer
[Pfizer ] .
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 .
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
Tau2 = 0.09, I2 = 26.0%, p = 0.015
Early treatment 45%
0.55 [0.34-0.89]
14/761
18/711
45% 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
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
OT1 CT2
Solaymani-.. (RCT) -19%
1.19 [0.70-2.04]
death
26/190
21/183
OT1
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 -79%
1.79 [0.33-8.02]
death
11/67
3/51
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
OT1
Alotaibi 57%
0.43 [0.18-1.01]
death
244 (n)
193 (n)
OT1
Tabarsi (RCT) 30%
0.70 [0.17-2.88]
death
3/32
4/30
OT1
Atipornwan.. (RCT) 23%
0.77 [0.35-1.67]
death
10/100
13/100
CT2
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
Tau2 = 0.12, I2 = 58.0%, p = 0.024
Late treatment 24%
0.76 [0.60-0.96]
220/2,080
238/2,834
24% improvement All studies 28%
0.72 [0.58-0.89]
234/2,841
256/3,545
28% improvement 26 favipiravir COVID-19 studies c19favipiravir.com Jan 16, 2022
Tau2 = 0.12, I2 = 55.9%, p = 0.0029
Effect extraction pre-specified, see appendix
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
B
C
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.
Results
Figure
3 ,
4 ,
5 ,
6 ,
7 ,
8 ,
9 ,
10 , and
11
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.
Table 1 summarizes the results by treatment stage.
Treatment time Number of studies reporting positive effects
Total number of studies Percentage of studies reporting positive effects
Random effects meta-analysis results
Early treatment
5
6
83.3%
45% improvement
Late treatment
12
20
60.0%
24% improvement
All studies
17
26
65.4%
28% improvement
Table 1. Results by treatment stage.
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
Tau2 = 0.09, I2 = 26.0%, p = 0.015
Early treatment 45%
0.55 [0.34-0.89]
14/761
18/711
45% 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
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
OT1 CT2
Solaymani-.. (RCT) -19%
1.19 [0.70-2.04]
death
26/190
21/183
OT1
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 -79%
1.79 [0.33-8.02]
death
11/67
3/51
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
OT1
Alotaibi 57%
0.43 [0.18-1.01]
death
244 (n)
193 (n)
OT1
Tabarsi (RCT) 30%
0.70 [0.17-2.88]
death
3/32
4/30
OT1
Atipornwan.. (RCT) 23%
0.77 [0.35-1.67]
death
10/100
13/100
CT2
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
Tau2 = 0.12, I2 = 58.0%, p = 0.024
Late treatment 24%
0.76 [0.60-0.96]
220/2,080
238/2,834
24% improvement All studies 28%
0.72 [0.58-0.89]
234/2,841
256/3,545
28% improvement 26 favipiravir COVID-19 studies c19favipiravir.com Jan 16, 2022
Tau2 = 0.12, I2 = 55.9%, p = 0.0029
Effect extraction pre-specified, see appendix
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 3. 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 Tau2 = 0.00, I2 = 0.0%, p = 0.37
Early treatment 33%
0.67 [0.28-1.61]
8/387
12/387
33% improvement Khamis (RCT) 15%
0.85 [0.28-2.59]
5/44
6/45
OT1 CT2
Improvement, RR [CI] Treatment Control Solaymani-.. (RCT) -19%
1.19 [0.70-2.04]
26/190
21/183
OT1
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 -79%
1.79 [0.33-8.02]
11/67
3/51
Alotaibi 57%
0.43 [0.18-1.01]
244 (n)
193 (n)
OT1
Tabarsi (RCT) 30%
0.70 [0.17-2.88]
3/32
4/30
OT1
Atipornwan.. (RCT) 23%
0.77 [0.35-1.67]
10/100
13/100
CT2
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
Tau2 = 0.05, I2 = 23.3%, p = 0.66
Late treatment -6%
1.06 [0.81-1.39]
120/1,510
103/2,345
-6% improvement All studies -3%
1.03 [0.80-1.33]
128/1,897
115/2,732
-3% improvement 13 favipiravir COVID-19 mortality results c19favipiravir.com Jan 16, 2022
Tau2 = 0.05, I2 = 22.2%, p = 0.83
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 4. Random effects meta-analysis for mortality results.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Solaymani-.. (RCT) -53%
1.53 [0.86-2.71]
27/190
17/183
OT1
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
Tau2 = 1.02, I2 = 82.2%, p = 0.72
Late treatment 18%
0.82 [0.29-2.32]
55/858
62/801
18% improvement All studies 18%
0.82 [0.29-2.32]
55/858
62/801
18% improvement 5 favipiravir COVID-19 mechanical ventilation results c19favipiravir.com Jan 16, 2022
Tau2 = 1.02, I2 = 82.2%, p = 0.72
1 OT: comparison with other treatment Favors favipiravir
Favors control
Figure 5. 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 Tau2 = 0.00, I2 = 0.0%, p = 0.19
Early treatment -619%
7.19 [0.38-138]
3/112
0/119
-619% improvement Khamis (RCT) -2%
1.02 [0.42-2.48]
8/44
8/45
OT1 CT2
Improvement, RR [CI] Treatment Control Solaymani-.. (RCT) -19%
1.19 [0.73-1.94]
31/190
25/183
OT1
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
OT1
Tabarsi (RCT) 41%
0.59 [0.22-1.59]
5/32
8/30
OT1
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
Tau2 = 0.00, I2 = 0.0%, p = 0.18
Late treatment -19%
1.19 [0.92-1.55]
79/917
75/922
-19% improvement All studies -21%
1.21 [0.93-1.57]
82/1,029
75/1,041
-21% improvement 8 favipiravir COVID-19 ICU results c19favipiravir.com Jan 16, 2022
Tau2 = 0.00, I2 = 0.0%, p = 0.15
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 6. 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
Tau2 = 1.09, I2 = 51.6%, p = 0.98
Early treatment 3%
0.97 [0.19-5.08]
9/299
8/249
3% 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)
OT1
Tau2 = 0.23, I2 = 16.3%, p = 0.78
Late treatment 13%
0.87 [0.34-2.20]
2/72
0/50
13% improvement All studies 2%
0.98 [0.44-2.19]
11/371
8/299
2% improvement 5 favipiravir COVID-19 hospitalization results c19favipiravir.com Jan 16, 2022
Tau2 = 0.29, I2 = 34.1%, p = 0.97
1 OT: comparison with other treatment Favors favipiravir
Favors control
Figure 7. 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
Tau2 = 0.08, I2 = 25.8%, p = 0.025
Early treatment 57%
0.43 [0.20-0.90]
5/75
7/74
57% improvement Chen (RCT) 74%
0.26 [0.03-2.28]
1/116
4/120
OT1
Improvement, RR [CI] Treatment Control Atipornwan.. (RCT) 60%
0.40 [0.20-0.79]
10/100
25/100
CT2
Tau2 = 0.00, I2 = 0.0%, p = 0.0039
Late treatment 62%
0.38 [0.20-0.74]
11/216
29/220
62% improvement All studies 60%
0.40 [0.25-0.62]
16/291
36/294
60% improvement 4 favipiravir COVID-19 progression results c19favipiravir.com Jan 16, 2022
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 8. 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) 16%
0.84 [0.54-1.29]
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)
Tau2 = 0.05, I2 = 53.1%, p = 0.13
Early treatment 19%
0.81 [0.62-1.06]
26/751
28/707
19% 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
OT1 CT2
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
OT1
Tabarsi (RCT) 6%
0.94 [0.72-1.23]
CT imp.
24/32
24/30
OT1
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)
Tau2 = 0.06, I2 = 77.1%, p = 0.029
Late treatment 19%
0.81 [0.67-0.98]
167/1,048
184/960
19% improvement All studies 19%
0.81 [0.70-0.95]
193/1,799
212/1,667
19% improvement 16 favipiravir COVID-19 recovery results c19favipiravir.com Jan 16, 2022
Tau2 = 0.06, I2 = 71.4%, p = 0.0073
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 9. Random effects meta-analysis for recovery.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Ruzhentsova (RCT) 22%
0.78 [0.92-1.79]
viral+
112 (n)
56 (n)
Improvement, RR [CI] Treatment Control Udwadia (RCT) 29%
0.71 [0.46-1.10]
viral time
75 (n)
75 (n)
Holubar (DB RCT) -32%
1.32 [0.83-2.08]
viral+
59 (n)
57 (n)
Alattar (PSM) 44%
0.56 [0.44-0.71]
viral+
78/387
139/387
Bosaeed (DB RCT) -15%
1.15 [0.75-1.75]
viral+
112 (n)
119 (n)
Tau2 = 0.10, I2 = 74.8%, p = 0.29
Early treatment 16%
0.84 [0.61-1.16]
78/745
139/694
16% improvement Cai 71%
0.29 [0.10-0.86]
viral+
35 (n)
45 (n)
Improvement, RR [CI] Treatment Control Ivashchenko (RCT) 46%
0.54 [0.33-0.88]
viral+
15/40
14/20
Pushkar (RCT) 90%
0.10 [0.02-0.40]
viral+
2/100
21/100
Zhao (RCT) 59%
0.41 [0.18-0.93]
viral+
7/36
9/19
Kulzhanova 50%
0.50 [0.21-1.20]
viral+
6/40
12/40
Atipornwan.. (RCT) 9%
0.91 [0.73-1.14]
viral time
50 (n)
50 (n)
CT1
Finberg (RCT) 47%
0.53 [0.29-0.98]
viral time
25 (n)
25 (n)
Tau2 = 0.21, I2 = 69.5%, p = 0.0013
Late treatment 52%
0.48 [0.31-0.75]
30/326
56/299
52% improvement All studies 33%
0.67 [0.53-0.86]
108/1,071
195/993
33% improvement 12 favipiravir COVID-19 viral clearance results c19favipiravir.com Jan 16, 2022
Tau2 = 0.11, I2 = 69.3%, p = 0.0014
1 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 10. Random effects meta-analysis for viral clearance.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Udwadia (RCT) 40%
0.60 [0.38-0.95]
recov. time
75 (n)
75 (n)
Improvement, RR [CI] Treatment Control Sawanpanyalert 68%
0.32 [0.15-0.66]
progression
n/a
n/a
Bosaeed (DB RCT) -619%
7.19 [0.38-138]
ICU
3/112
0/119
Tau2 = 0.28, I2 = 60.1%, p = 0.16
Early treatment 45%
0.55 [0.24-1.26]
3/187
0/194
45% 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
Khamis (RCT) 15%
0.85 [0.28-2.59]
death
5/44
6/45
OT1 CT2
Solaymani-.. (RCT) -19%
1.19 [0.70-2.04]
death
26/190
21/183
OT1
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 -79%
1.79 [0.33-8.02]
death
11/67
3/51
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
OT1
Alotaibi 57%
0.43 [0.18-1.01]
death
244 (n)
193 (n)
OT1
Tabarsi (RCT) 30%
0.70 [0.17-2.88]
death
3/32
4/30
OT1
Atipornwan.. (RCT) 23%
0.77 [0.35-1.67]
death
10/100
13/100
CT2
Damayanti 54%
0.46 [0.22-0.92]
no recov.
96 (n)
96 (n)
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
Tau2 = 0.21, I2 = 59.9%, p = 0.032
Late treatment 28%
0.72 [0.54-0.97]
133/1,805
142/2,556
28% improvement All studies 31%
0.69 [0.53-0.91]
136/1,992
142/2,750
31% improvement 21 favipiravir COVID-19 peer reviewed trials c19favipiravir.com Jan 16, 2022
Tau2 = 0.20, I2 = 60.0%, p = 0.0088
Effect extraction pre-specified, see appendix
1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir
Favors control
Figure 11. Random effects meta-analysis for peer reviewed studies.
Effect extraction is pre-specified, using the most serious outcome reported,
see the
appendix for details.
Exclusions
To avoid bias in the selection of studies, we analyze all
non-retracted studies. Here we show the results after excluding studies with
major issues likely to alter results, non-standard studies, and studies where
very minimal detail is currently available. Our bias evaluation is based on
analysis of each study and identifying when there is a significant chance that
limitations will substantially change the outcome of the study. We believe
this can be more valuable than checklist-based approaches such as Cochrane
GRADE, which may underemphasize serious issues not captured in the checklists,
overemphasize issues unlikely to alter outcomes in specific cases (for
example, lack of blinding for an objective mortality outcome, or certain
specifics of randomization with a very large effect size), or be easily
influenced by potential bias. However, they can also be very high
quality.
The studies excluded are as below.
Figure 12 shows a forest plot for random
effects meta-analysis of all studies after exclusions.
[Assiri ] , unadjusted results with no group details.
[Khamis ] , trials compares against another treatment showing significant efficacy in trials.
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
Tau2 = 0.09, I2 = 26.0%, p = 0.015
Early treatment 
