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Favipiravir for COVID-19: real-time meta analysis of 45 studies
Covid Analysis, August 18, 2022, DRAFT
https://c19favipiravir.com/meta.html
0 0.5 1 1.5+ All studies 29% 45 17,956 Improvement, Studies, Patients Relative Risk Mortality 17% 23 14,012 Ventilation 14% 6 9,313 ICU admission -21% 15 3,151 Hospitalization 10% 13 2,103 Progression 45% 6 8,332 Recovery 17% 18 3,816 Viral clearance 30% 21 4,140 RCTs 26% 24 3,723 Peer-reviewed 33% 40 16,355 Early 41% 13 9,970 Late 24% 32 7,986 Favipiravir for COVID-19 c19favipiravir.com Aug 2022 Favorsfavipiravir Favorscontrol after exclusions
Statistically significant improvements are seen for progression, recovery, and viral clearance. 24 studies from 24 independent teams in 16 different countries show statistically significant improvements in isolation (14 for the most serious outcome).
Meta analysis using the most serious outcome reported shows 29% [17‑39%] improvement. Results are similar for Randomized Controlled Trials, similar after exclusions, and similar for peer-reviewed studies. Early treatment is more effective than late treatment.
Results are robust — in exclusion sensitivity analysis 14 of 45 studies must be excluded to avoid finding statistically significant efficacy in pooled analysis.
0 0.5 1 1.5+ All studies 29% 45 17,956 Improvement, Studies, Patients Relative Risk Mortality 17% 23 14,012 Ventilation 14% 6 9,313 ICU admission -21% 15 3,151 Hospitalization 10% 13 2,103 Progression 45% 6 8,332 Recovery 17% 18 3,816 Viral clearance 30% 21 4,140 RCTs 26% 24 3,723 Peer-reviewed 33% 40 16,355 Early 41% 13 9,970 Late 24% 32 7,986 Favipiravir for COVID-19 c19favipiravir.com Aug 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 7% 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 progression, viral clearance, and in pooled analysis, high confidence for recovery, and very low confidence for mortality, however increased risk is seen with 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 43 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) Qadir 97% 0.03 [0.00-0.47] death 0/125 17/125 Usanma Koban 86% 0.14 [0.02-0.70] viral+ 47 (n) 79 (n) Sirijatuphat (RCT) 64% 0.36 [0.20-0.64] improv. 62 (n) 31 (n) McMahon (RCT) -1% 1.01 [0.34-3.03] oxygen 6/99 6/100 Tau​2 = 0.22, I​2 = 51.2%, p = 0.011 Early treatment 41% 0.59 [0.39-0.89] 31/3,718 47/6,252 41% 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 Tawfik 96% 0.04 [0.00-0.26] death 1/103 17/62 Tau​2 = 0.07, I​2 = 65.2%, p = 0.0016 Late treatment 24% 0.76 [0.65-0.90] 361/3,032 415/4,954 24% improvement All studies 29% 0.71 [0.61-0.83] 392/6,750 462/11,206 29% improvement 45 favipiravir COVID-19 studies c19favipiravir.com Aug 2022 Tau​2 = 0.09, I​2 = 66.6%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 6% hospitalization Improvement Relative Risk [CI] Udwadia (RCT) 40% recovery Sawanpanyalert 68% progression Holubar (DB RCT) 89% hospitalization Alattar (PSM) 33% death Bosaeed (DB RCT) -619% ICU admission Lowe (DB RCT) -196% ICU admission Adhikari (RCT) -40% improvement Tsuzuki 13% death Qadir 97% death Usanma Koban 86% viral- Sirijatuphat (RCT) 64% improv. McMahon (RCT) -1% oxygen therapy Tau​2 = 0.22, I​2 = 51.2%, p = 0.011 Early treatment 41% 41% improvement Cai 69% pneumonia Ivashchenko (RCT) 46% viral- Lou (RCT) -422% ICU admission Pushkar (RCT) 14% recovery Khamis (RCT) 15% death OT​1 CT​2 Solaymani.. (RCT) -19% death OT​1 Zhao (RCT) 59% viral- Aghajani 26% death Alamer -56% death Almoosa -42% death Shinkai (SB RCT) 37% imp. time Assiri (ICU) -79% death ICU patients Kulzhanova 88% improvement Chen (RCT) -3% ICU admission OT​1 Alotaibi 57% death OT​1 Tabarsi (RCT) 30% death OT​1 Atipornwa.. (RCT) 23% death OT​1 CT​2 Damayanti 54% recovery Shenoy (DB RCT) -29% death Chuah (RCT) -1154% death Finberg (RCT) -200% death Al Mutair (ICU) 7% death ICU patients OT​1 Kurniyanto 48% death Cilli 38% death Yulia 85% death Uyaroğlu (PSM) 67% death OT​1 AlQahtani (RCT) -196% death Shinada 7% hospitalization Hassaniazad (RCT) 68% death OT​1 Hafez -3% viral- CT​2 Rahman (DB RCT) 89% improvement Tawfik 96% death Tau​2 = 0.07, I​2 = 65.2%, p = 0.0016 Late treatment 24% 24% improvement All studies 29% 29% improvement 45 favipiravir COVID-19 studies c19favipiravir.com Aug 2022 Tau​2 = 0.09, I​2 = 66.6%, p < 0.0001 Effect extraction pre-specifiedRotate device for footnotes/details 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 AUG 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 9 13 69.2% 41% improvement
RR 0.59 [0.39‑0.89]
p = 0.011
Late treatment 21 32 65.6% 24% improvement
RR 0.76 [0.65‑0.90]
p = 0.0016
All studies 30 45 66.7% 29% improvement
RR 0.71 [0.61‑0.83]
p < 0.0001
Table 1. Results by treatment stage.
Studies Early treatment Late treatment PatientsAuthors
All studies 4541% [11‑61%]24% [10‑35%] 17,956 684
With exclusions 3941% [11‑61%]19% [4‑32%] 16,869 633
Peer-reviewed 4045% [11‑66%]28% [12‑41%] 16,355 601
Randomized Controlled TrialsRCTs 2428% [-22‑57%]23% [2‑40%] 3,723 448
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) Qadir 97% 0.03 [0.00-0.47] death 0/125 17/125 Usanma Koban 86% 0.14 [0.02-0.70] viral+ 47 (n) 79 (n) Sirijatuphat (RCT) 64% 0.36 [0.20-0.64] improv. 62 (n) 31 (n) McMahon (RCT) -1% 1.01 [0.34-3.03] oxygen 6/99 6/100 Tau​2 = 0.22, I​2 = 51.2%, p = 0.011 Early treatment 41% 0.59 [0.39-0.89] 31/3,718 47/6,252 41% 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 Tawfik 96% 0.04 [0.00-0.26] death 1/103 17/62 Tau​2 = 0.07, I​2 = 65.2%, p = 0.0016 Late treatment 24% 0.76 [0.65-0.90] 361/3,032 415/4,954 24% improvement All studies 29% 0.71 [0.61-0.83] 392/6,750 462/11,206 29% improvement 45 favipiravir COVID-19 studies c19favipiravir.com Aug 2022 Tau​2 = 0.09, I​2 = 66.6%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) 1 OT: comparison with other treatment2 CT: study uses combined treatment Favors favipiravir Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Ruzhentsova (RCT) 6% hospitalization Improvement Relative Risk [CI] Udwadia (RCT) 40% recovery Sawanpanyalert 68% progression Holubar (DB RCT) 89% hospitalization Alattar (PSM) 33% death Bosaeed (DB RCT) -619% ICU admission Lowe (DB RCT) -196% ICU admission Adhikari (RCT) -40% improvement Tsuzuki 13% death Qadir 97% death Usanma Koban 86% viral- Sirijatuphat (RCT) 64% improv. McMahon (RCT) -1% oxygen therapy Tau​2 = 0.22, I​2 = 51.2%, p = 0.011 Early treatment 41% 41% improvement Cai 69% pneumonia Ivashchenko (RCT) 46% viral- Lou (RCT) -422% ICU admission Pushkar (RCT) 14% recovery Khamis (RCT) 15% death OT​1 CT​2 Solaymani.. (RCT) -19% death OT​1 Zhao (RCT) 59% viral- Aghajani 26% death Alamer -56% death Almoosa -42% death Shinkai (SB RCT) 37% imp. time Assiri (ICU) -79% death ICU patients Kulzhanova 88% improvement Chen (RCT) -3% ICU admission OT​1 Alotaibi 57% death OT​1 Tabarsi (RCT) 30% death OT​1 Atipornwa.. (RCT) 23% death OT​1 CT​2 Damayanti 54% recovery Shenoy (DB RCT) -29% death Chuah (RCT) -1154% death Finberg (RCT) -200% death Al Mutair (ICU) 7% death ICU patients OT​1 Kurniyanto 48% death Cilli 38% death Yulia 85% death Uyaroğlu (PSM) 67% death OT​1 AlQahtani (RCT) -196% death Shinada 7% hospitalization Hassaniazad (RCT) 68% death OT​1 Hafez -3% viral- CT​2 Rahman (DB RCT) 89% improvement Tawfik 96% death Tau​2 = 0.07, I​2 = 65.2%, p = 0.0016 Late treatment 24% 24% improvement All studies 29% 29% improvement 45 favipiravir COVID-19 studies c19favipiravir.com Aug 2022 Tau​2 = 0.09, I​2 = 66.6%, p < 0.0001 Effect extraction pre-specifiedRotate device for footnotes/details 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) Qadir 97% 0.03 [0.00-0.47] 0/125 17/125 Tau​2 = 0.44, I​2 = 64.5%, p = 0.24 Early treatment 45% 0.55 [0.21-1.48] 8/3,044 29/5,634 45% 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 Tawfik 96% 0.04 [0.00-0.26] 1/103 17/62 Tau​2 = 0.11, I​2 = 45.8%, p = 0.29 Late treatment 13% 0.87 [0.67-1.13] 258/2,358 272/2,976 13% improvement All studies 17% 0.83 [0.65-1.07] 266/5,402 301/8,610 17% improvement 23 favipiravir COVID-19 mortality results c19favipiravir.com Aug 2022 Tau​2 = 0.12, I​2 = 47.0%, p = 0.15 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 Aug 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.