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Repurposing of Favipiravir for the Treatment COVID-19: A Meta-analysis

Velichka Pavlova, Katya Uzunova, Elena Filipova, Krassimir Kalinov, Toni Vekov

Background: The outbreak of coronavirus disease 2019 (COVID-19) originating from Wuhan, Hubei Province, China at the end of 2019 led to dramatic changes in the healthcare and socioeconomic sectors across the globe. The aim of this meta-analysis was to assess whether favipiravir is a safe and effective option for treatment of COVID-19 patients compared with standard of care (SOC) and/or other applied medicines.

Methods: Data bases were searched up to 31^st May 2021 for studies that compare the efficacy and safety of favipiravir and SOC or other relevant therapy in COVID-19 patients. Search results were assessed for relevance on the basis of the following inclusion criteria and relevant results were subjected to a quality estimation using the EPHPP Quality assessment tool.

Results: A total of 10 articles with hospitalized patients and outpatients (n=1016) met our inclusion criteria. Pooled RR 1.24 (95% CI 1.08-1.43, n=5) showed clinical improvement by Day 7 and Day 14 (pooled RR 1.18 (95% CI 1.01-1.37, n=5) and favipiravir was associated with 24% and 18% better outcome compared to other treatment, respectively. Viral clearance by Day 7 and Day 14 with favipiravir was comparable to other treatments (RR 1.1; 95% CI 0.92-1.35, n=5) and (RR 1.07, 95% CI 0.88-1.29, n=5). Safety profile of favipiravir was comparable to that of other treatments (RR 1.21; 95% CI 0.88-1.67) and SEA including death were comparable between treatments (RR 0.64, 95% CI 0.15-2.68, n=4 studies). No correlation between incidence of SEA and treatment option was identified.

Conclusion: There is a significant difference in the clinical improvement detected on Days 7 and 14 in favour of favipiravir. Viral clearance at Days 7 and 14 is comparable between treatments with neither being associated with significantly better outcomes. The safety profiles of favipiravir and SOC regarding SAE show no statistically significant differences.