Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Favipiravir vs Standard care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022.

Study Dabbous HM, Scientific Reports, 2021 has been retracted on September 18, 2021. The study was excluded from the analysis and grade assessment by October 10 the latest.

Outpatients

Forest plots
(last update: 2023-02-23)

Summary of findings
(last update: 2022-12-20)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Favipiravir
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.01 (0.96 - 1.06)	9 more per 1000 (from 34 fewer to 51 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
1 trials Golan Y, 2022 1211 participants		Favipiravir 862 per 1,000 (819 - 905)	Standard care/Placebo 854 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death	RR: 1.10 (0.52 - 2.32)	8 more per 1000 (from 37 fewer to 103 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
5 trials Tehrani S, 2022; Bosaeed M, 2022; Holubar M, 2021; Lowe DM, 2022; McMahon J, 2022 790 participants		Favipiravir 86 per 1,000 (41 - 181)	Standard care/Placebo 78 per 1,000
WHO progression score (level 7 or above) D28	RR: 3.05 (0.13 - 73.39)	Absolute effects were not calculated due to zero events in the control group		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials McMahon J, 2022; Lowe DM, 2022 218 participants		Favipiravir 0 per 1,000 ( - )	Standard care/Placebo 0 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.33 (0.01 - 8.05)	1 fewer per 1000 (from 1 fewer to 7 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
7 trials Bosaeed M, 2022; Zhao H, 2021; Holubar M, 2021; Lowe DM, 2022; McMahon J, 2022; Golan Y, 2022; Tehrani S, 2022 2056 participants		Favipiravir 0 per 1,000 (0 - 8)	Standard care/Placebo 1 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	RR: 1.03 (0.91 - 1.16)	15 more per 1000 (from 45 fewer to 80 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
4 trials Bosaeed M, 2022; Holubar M, 2021; Lowe DM, 2022; Golan Y, 2022 712 participants		Favipiravir 518 per 1,000 (458 - 583)	Standard care/Placebo 503 per 1,000
Adverse events	RR: 0.99 (0.87 - 1.14)	2 fewer per 1000 (from 29 fewer to 31 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
6 trials Golan Y, 2022; Bosaeed M, 2022; Zhao H, 2021; Molubar M, 2021; Lowe DM, 2022; McMahon J, 2022 1978 participants		Favipiravir 220 per 1,000 (193 - 253)	Standard care/Placebo 222 per 1,000
Serious adverse events	RR: 1.13 (0.65 - 1.97)	3 more per 1000 (from 9 fewer to 24 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
6 trials Golan Y, 2022; Bosaeed M, 2022; Zhao H, 2021; Holubar M, 2021; Lowe DM, 2022; McMahon J, 2022 1978 participants		Favipiravir 28 per 1,000 (16 - 48)	Standard care/Placebo 25 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Hospitalized patients

Forest plots
(last update: 2023-01-06)

Funnel plots
(last update: 2022-10-24)

Summary of findings
(last update: 2023-04-20)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Favipiravir
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.00 (0.97 - 1.03)	0 fewer per 1000 (from 22 fewer to 22 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, missing data, outcome measurement and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
10 trials Al Qahtani M, 2022; Chuah CH, 2021; Udwadia Z, 2020; Ruzhentsova TA, 2020; Balyakova L, 2020; Ivashchenko AA, 2020; Finberg RW, 2021; Shenoy S, 2021; Lou Y, 2020; Rahman SMA, 2022 1664 participants		Favipiravir 730 per 1,000 (709 - 752)	Standard care/Placebo 730 per 1,000
Clinical improvement D60	RR: 1.00 (0.85 - 1.18)	0 fewer per 1000 (from 138 fewer to 166 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, missing data, and outcome measurement Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Finberg RW, 2021 50 participants		Favipiravir 920 per 1,000 (782 - 1000)	Standard care/Placebo 920 per 1,000
WHO progression score (level 7 or above) D28	RR: 1.03 (0.34 - 3.10)	0 fewer per 1000 (from 9 fewer to 27 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
5 trials Balykova L, 2020; Lou Y, 2020, Udiwadia Z, 2020; Finberg RW, 2021; Chuah CH, 2021 920 participants		Favipiravir 13 per 1,000 (4 - 40)	Standard care/Placebo 13 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
WHO progression score (level 7 or above) D60	RR: 3.00 (0.13 - 70.30)	Absolute effects were not calculated due to zero events in the control group		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, and missing data Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Finberg RW, 2021 50 participants		Favipiravir 0 per 1,000 (* - *)	Standard care/Placebo 0 per 1,000
All-cause mortality D28	RR: 1.43 (0.71 - 2.88)	6 more per 1000 (from 4 fewer to 28 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with adequate randomisation, deviation from intended intervetion, missing data, and selection of the reported results, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for trivial effect/no effect and the possibility for harm
10 trials Sirijatuphat R, 2022; AlQahtani M, 2022; Balykova L, 2020; Lou Y, 2020; Udwadia Z, 2020; Shinkai M, 2021; Finberg RW, 2021, Shenoy S, 2021; Chuah CH, 2021; Adhikari P, 2022 1701 participants		Favipiravir 21 per 1,000 (11 - 43)	Standard care/Placebo 15 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
All-cause mortality D60	RR: 3.00 (0.13 - 70.30)	Absolute effects were not calculated due to zero events in the control group		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns with deviation from intended intervention,and missing data Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Finberg RW, 2021 50 participants		Favipiravir 0 per 1,000 (* - *)	Standard care/Placebo 0 per 1,000
Viral negative conversion D7	RR: 1.17 (1.04 - 1.33)	105 more per 1000 (from 25 more to 204 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
8 trials AlQahtani M, 2022; Udwadia Z, 2020; Ruzhentsova TA, 2020; Balyakova L, 2020; Ivashchenko AA, 2020; Finberg RW, 2021; Lou Y, 2020; Rahman SMA, 2022 784 participants		Favipiravir 724 per 1,000 (643 - 823)	Standard care/Placebo 619 per 1,000	2 additional studies were identified that assessed this outcome, but no results were reported.
Adverse events	RR: 1.59 (1.04 - 2.43)	108 more per 1000 (from 7 more to 262 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviations from intended intervention, missing data outcome measurement and selection of reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=83.5% Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
8 trials Chuah CH, 2021; Balykova L, 2020; Ivashchenko AA, 2020; Ruzhentsova T, 2020; Udwadia Z, 2020; Finberg RW, 2021; Shenoy S, 2021; Shinkai M, 2021 1637 participants		Favipiravir 291 per 1,000 (191 - 445)	Standard care/Placebo 183 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.
Serious adverse events	RR: 1.22 (0.75 - 1.98)	9 more per 1000 (from 11 fewer to 42 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, missing data, outcome measurement and selection of reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
9 trials Sirijatuphat R, 2022; Balykova L, 2020; Lou Y, 2020; Ruzhentsova T, 2020; Udwadia Z, 2020; Shinkai M, 2021; Findberg RW, 2021; Shenoy S, 2021; Adhikari P, 2022 1263 participants		Favipiravir 53 per 1,000 (32 - 85)	Standard care/Placebo 43 per 1,000	1 additional study was identified that assessed this outcome, but no results were reported.

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

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click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=43

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04445467 VIRCO McMahon JH, EClinicalMedicine, 2022 Full text Full text Commentary	Mixed	Favipiravir	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated by a single center in Australia	N=199	Some concerns Details	Full description
NCT04694612 Adhikari P, Int J Infect Dis, 2022 a Full text Commentary	Not reported/unclear	Favipiravir	Placebo	RCT	Patients with confirmed COVID-19 (mild) admitted to 9 centers in Nepal	N=70	Some concerns Details	Full description
NCT04600895 PRESECO Golan Y, Clin Infect Dis, 2022 Full text Commentary Commentary	Private	Favipiravir	Placebo	RCT	Outpatients with confirmed COVID-19 (mild-moderate) treated by 40 centers in the USA (27 sites), Brazil (7 sites) and Mexico (6 sites).	N=1211	Some concerns Details	Full description
IRCT20211004052664N1 Tehrani S, Mediterr J Infect Microbes Antimicrob, 2022 Full text Commentary	No specific funding	Favipiravir	Standard care	RCT	Outpatients with confirmed COVID-19 (moderate) treated by a single center in Iran.	N=78	Some concerns Details	Full description
TCTR20200514001 Sirijatuphat R, Emerg Microbes Infect, 2022 Full text Commentary	Mixed	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (mild) admitted to three centers in Thailand	N=96	Some concerns Details	Full description
NCT04402203 Rahman SMA, Clin Infect Pract, 2022 Full text Commentary	Private	Favipiravir	Placebo	RCT	Patients with confirmed COVID-19 (mild-moderate) admitted to 4 centers in Bangladesh.	N=57	High Details	Full description
NCT04387760 AlQahtani M, Sci Rep, 2022 Full text Commentary Commentary	Public/non profit	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (mild) admitted to 2 centers in Bahrain	N=106	Some concerns Details	Full description
NCT04499677 FLARE Lowe DM, PLoS Med, 2022 Full text Full text Commentary Commentary Commentary	Mixed	Favipiravir Lopinavir + Ritonavir Lopinavir + Ritonavir + Favipiravir Favipiravir	Placebo Placebo Placebo Lopinavir + Ritonavir	RCT	Outpatients with confirmed COVID-19 (mild) treated by 2 centers in the UK	N=240	Some concerns Details	Full description
NCT04346628 Holubar M, Clin Infect Dis, 2022 Full text Full text Commentary Commentary Commentary	Public/non profit	Favipiravir	Placebo	RCT	Outpatients with confirmed COVID-19 (asymptomatic and mild ambulatory) treated by a single center in the USA	N=149	Some concerns Details	Full description
NCT04529499; IND148286 Shenoy S, medRxiv, 2021 Full text Full text Commentary Commentary	Private	Favipiravir	Placebo	RCT	Patients with confirmed COVID-19 (mild to critical) admitted to 3 centers in Kuwait.	N=353	Low Details	Full description
NCT04464408 Bosaeed M, Clin Microbiol Infect, 2022 Full text Commentary	Public/non profit	Favipiravir	Placebo	RCT	Outpatients with confirmed COVID-19 (mild-ambulatory) treated by 7 centers in Saudi Arabia	N=245	Some concerns Details	Full description
NCT04818320 Chuah CH, Clin Infect Dis, 2021 Full text Commentary Commentary	No specific funding	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (mild/moderate) admitted to 14 centers in Malaysia.	N=500	Some concerns Details	Full description
NCT04358549 Finberg RW, Open Forum Infect Dis, 2021 Full text Commentary Commentary	Mixed	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (mild-severe) admitted to 7 centers in the USA	N=50	Some concerns Details	Full description
JapicCTI-205238 Shinkai M, Infect Dis Ther, 2021 Full text Commentary	Private	Favipiravir	Placebo	RCT	Patients with confirmed COVID-19 (mild/moderate) admitted to 39 centers in Japan.	N=156	Some concerns Details	Full description
NCT04434248 Ivashchenko AA, Clin Infect Dis, 2020 Full text Commentary	Mixed	Favipiravir 1800/800mg Favipiravir 1600/600mg Favipiravir 1800/800mg	Standard care Standard care Favipiravir 1600/600mg	RCT	Patients with confirmed COVID-19 (mild-moderate) admitted to 6 centers in Russia	N=60	Some concerns Details	Full description
NCT04333589 Zhao H, Int Immunopharmacol, 2021 Full text Commentary	Public/non profit	Favipiravir	Standard care	RCT	Outpatients whith confirmed recurrent COVID-19 (mild),isolated and treated by 5 centres in China.	N=55	Some concerns Details	Full description
CTRI/2020/05/025114 Udwadia Z, Int J Infect Dis, 2020 Full text Commentary	Private	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (mild/moderate) admitted to 7 centers in India	N=150	Some concerns Details	Full description
NCT04501783 Ruzhentsova TA, Am J Transl Res, 2021 Full text Full text Commentary Commentary	Private	Favipiravir	Standard care	RCT	Outpatients and inpatients with confirmed COVID-19 (mild-moderate) treated at 10 centers in Russia	N=168	Some concerns Details	Full description
NCT04542694 Balykova L, Infektsionnye bolezn, 2020 Full text Commentary	Private	Favipiravir	Standard care	RCT	Patients with confirmed COVID-19 (moderate) admitted to 5 centers in Russia	N=200	Some concerns Details	Full description
ChiCTR2000029544 Lou Y, Eur J Pharm Sci, 2020 Full text Commentary	Public/non profit	Favipiravir Baloxavir marboxil Favipiravir	Standard care Standard care Baloxavir marboxil	RCT	Patients with confirmed COVID-19 (unclear severity) admitted to a single center in China	N=30	Some concerns Details	Full description