Objectives This study aimed to evaluate the efficacy and adverse events of favipiravir in patients with COVID-19. Methods Our protocol was registered on PROSPERO (CRD42020206305). Fourteen databases were searched until February 8 th , 2021. An update search for new RCTs was done on March 2 nd , 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.
【저자키워드】 OR, odds ratio, WHO, World Health Organization, CI, Confidence interval, CT, Computed tomography, RNA, Ribonucleic acid, RdRp, RNA-dependent-RNA-polymerase, NIH, National Institutes of Health, SD, standard deviation, RCT, Randomized controlled trial, PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, RR, risk ratio, Favipiravir, COVID-19, SARS-CoV-2, Efficacy, side effects, AIC, akaike information criterion, CCA, Cancer Council Australia, FEM, fixed-effect model, GRADE, The Grading of Recommendations Assessment, Development and Evaluation, MD, mean difference, REM, random-effect model, RoB 2, cochrane collaboration's risk of bias tool for randomized trials, ROBIN-I, cochrane collaboration's risk of bias tool for nonrandomized studies of interventions,