The efficacy and adverse effects of favipiravir on patients with COVID-19: A systematic review and meta-analysis of published clinical trials and observational studies
Dang The Hung, Suhaib Ghula, Jeza Muhamad Abdul Aziz, Abdelrahman M Makram, Gehad Mohamed Tawfik, Ali Ahmed‐Fouad Abozaid, Rohan Pancharatnam, Amr Mohamed Ibrahim, Muhammad Besher Shabouk, Morgan Turnage, Saloni Nakhare, Zahra Karmally, Basel Kouz, Tran Le, Suleiman Alhijazeen, Nguyen Quoc Phuong, Alaa Mohamed Ads, Ali Hussein Abdelaal, Nguyen Hai Nam, Tatsuo Iiyama, Kyoshi Kita, Kenji Hirayama, Nguyen Tien Huy
Abstract
OBJECTIVES: This study aimed to evaluate the efficacy and adverse events of favipiravir in patients with COVID-19. METHODS: , 2022. Meta-analysis was done for randomized controlled trials (RCTs) and non-RCTs. RESULTS: Overall, 157 studies (24 RCTs, 1 non-RCT, 21 observational studies, 2 case series, and 106 case reports) were included. On hospitalized patients, in comparison to standard of care, favipiravir showed a higher rate of viral clearance at day 5 (RR = 1.60, p = 0.02), defervescence at day 3-4 (RR = 1.99, p <0.01), chest radiological improvement (RR = 1.33, p <0.01), hospital discharge at day 10-11 (RR = 1.19, p <0.01), and shorter clinical improvement time (MD = -1.18, p = 0.05). Regarding adverse events, favipiravir groups had higher rates of hyperuricemia (RR = 9.42, p <0.01), increased alanine aminotransferase (RR = 1.35, p <0.01) but lower rates of nausea (RR = 0.42, p <0.01) and vomiting (R R= 0.19, p=0.02). There were no differences regarding mortality (RR=1.19, p=0.32), and increased aspartate aminotransferase (RR = 1.11, p = 0.25). On nonhospitalized patients, no significant differences were reported. CONCLUSIONS: Adding favipiravir to the standard of care provides better outcomes for hospitalized patients with COVID-19. Pregnant, lactating women, and patients with a history of hyperuricemia should avoid using favipiravir.