Favipiravir does not improve viral clearance in mild to moderate COVID-19 – A systematic review and meta-analysis of randomized controlled trials
Muh Akbar Bahar,
Ikhwan Yuda Kusuma,
Ádám Visnyovszki,
Mária Matuz,
Ria Benkő,
Tamás Ferenci,
Bálint Gergely Szabó,
Edit Hajdú,
Zoltán Pető,
Dezső Csupor
Affiliations
Muh Akbar Bahar
Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary; Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
Ikhwan Yuda Kusuma
Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary; Pharmacy Study Program, Universitas Harapan Bangsa, Purwokerto, Indonesia
Ádám Visnyovszki
Internal Medicine Clinic, Infectiology Unit, Albert Szent Györgyi Medical Center, Szeged, Hungary
Mária Matuz
Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
Ria Benkő
Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary; Central Pharmacy, Albert Szent Györgyi Medical Center, Szeged, Hungary
Tamás Ferenci
Physiological Controls Research Center, Óbuda University, Budapest, Hungary; Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
Bálint Gergely Szabó
South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary; Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
Edit Hajdú
Internal Medicine Clinic, Infectiology Unit, Albert Szent Györgyi Medical Center, Szeged, Hungary
Zoltán Pető
Emergency Care Department, Albert Szent-Györgyi Medical Center, Szeged, Hungary
Dezső Csupor
Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary; Institute for Translational Medicine, University of Pécs, Pécs, Hungary; Corresponding author. Institute of Clinical Pharmacy, University of Szeged, H-6725 Szeged, Szikra u. 8, Hungary.
Purpose: Favipiravir has been used in the therapy of COVID-19, including patients with mild to moderate symptoms in certain countries. The aim of our systematic review and meta-analysis was to investigate its efficacy and safety in mild-to-moderate COVID-19 infections. Methods: The PubMed, Embase, Web of Science, and Cochrane databases were systematically reviewed for articles reporting the results of randomized controlled trials published until January 6, 2023, resulting in the identification of 20 eligible studies. Results: There were no significant differences in viral clearance time (HR = 1.20, p = 0.09) compared to those without favipiravir therapy. However, in the subgroup analyses, favipiravir treatment significantly increased viral clearance by 59 % (HR = 1.59, p < 0.01) and 42 % (HR = 1.42, p < 0.01], I2 = 20 %) compared to the comparator group in patients with moderate severity of COVID-19 and in the inpatient care setting, respectively. Favipiravir had no beneficial effects in the case of patients with mild symptoms and treated in ambulatory care. Conclusions: The use of favipiravir is questionable in the treatment of outpatients with COVID-19 with mild symptoms. Moderate beneficial effects in the case of patients with moderate symptoms and inpatients should be treated with care due to the limitations of the analysed trials.
