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70 favipiravir COVID-19 controlled studies, 34 RCTs
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2+ Ruzhentsova (RCT) 6% 0.94 [0.78-1.14] hosp. 3/112 2/56 Improvement, RR [CI] Treatment Control Ruzhentsova (RCT) 39% 0.61 [0.43-0.88] no recov. 112 (n) 56 (n) Ruzhentsova (RCT) 22% 0.78 [0.92-1.79] viral+ 112 (n) 56 (n) Udwadia (RCT) 66% 0.34 [0.01-8.12] death 0/73 1/75 Udwadia (RCT) 29% 0.71 [0.49-1.03] no recov. 75 (n) 72 (n) Udwadia (RCT) 43% 0.57 [0.36-0.91] no recov. 75 (n) 72 (n) Udwadia (RCT) 27% 0.73 [0.51-1.06] viral time 75 (n) 72 (n) Sawanpanyalert 68% 0.32 [0.15-0.66] progression n/a n/a Holubar (DB RCT) 89% 0.11 [0.01-2.02] hosp. 0/75 4/74 Holubar (DB RCT) 30% 0.70 [0.23-2.12] ER visit 5/75 7/74 Holubar (DB RCT) -19% 1.19 [0.78-1.85] no recov. 65 (n) 70 (n) Holubar (DB RCT) -32% 1.32 [0.83-2.08] viral+ 59 (n) 57 (n) Alattar (PSM) 33% 0.67 [0.28-1.61] death 8/387 12/387 Alattar (PSM) -2% 1.02 [0.90-1.16] no recov. 26/387 28/387 Alattar (PSM) -6% 1.06 [0.99-1.14] recov. time 387 (n) 387 (n) Alattar (PSM) 44% 0.56 [0.44-0.71] viral+ 78/387 139/387 Bosaeed (DB RCT) -619% 7.19 [0.38-138] ICU 3/112 0/119 Bosaeed (DB RCT) -219% 3.19 [0.66-15.5] hosp. 6/112 2/119 Bosaeed (DB RCT) -12% 1.12 [0.80-1.56] no recov. 112 (n) 119 (n) Bosaeed (DB RCT) -15% 1.15 [0.75-1.75] viral+ 112 (n) 119 (n) FLARE Lowe (DB RCT) -202% 3.02 [0.13-72.6] ICU 1/59 0/60 FLARE Lowe (DB RCT) -202% 3.02 [0.13-72.6] hosp. 1/59 0/60 FLARE Lowe (DB RCT) 28% 0.72 [0.44-0.98] viral+ 29/54 38/52 Adhikari (RCT) -40% 1.40 [0.57-3.44] no improv. 10/38 6/32 Adhikari (RCT) -36% 1.36 [0.52-3.59] no improv. 8/27 5/23 Adhikari (RCT) -64% 1.64 [0.18-15.3] no improv. 2/11 1/9 Tsuzuki 13% 0.87 [0.52-1.46] death 2,532 (n) 5,122 (n) Tsuzuki -2% 1.02 [0.65-1.60] ventilation 2,532 (n) 5,122 (n) Tsuzuki 18% 0.82 [0.66-1.04] progression 2,532 (n) 5,122 (n) Qadir 97% 0.03 [0.00-0.47] death 0/125 17/125 Qadir 60% 0.40 [0.23-0.71] hosp. 14/125 35/125 Qadir 97% 0.03 [0.00-0.47] no recov. 0/125 17/125 Qadir 71% 0.29 [0.17-0.50] no recov. 14/125 48/125 Qadir 79% 0.21 [0.13-0.36] no recov. 14/125 66/125 Qadir 71% 0.29 [0.22-0.40] no recov. 32/125 109/125 Qadir 58% 0.42 [0.25-0.70] recov. time 125 (n) 125 (n) Usanma Koban 86% 0.14 [0.02-0.70] viral+ 47 (n) 79 (n) Sirijatuphat (RCT) 64% 0.36 [0.20-0.64] improv. 62 (n) 31 (n) Sirijatuphat (RCT) 90% 0.10 [0.03-0.39] improv. 62 (n) 31 (n) Sirijatuphat (RCT) 43% 0.57 [0.23-1.43] progression 8/62 7/31 Sirijatuphat (RCT) -4% 1.04 [0.63-1.72] viral+ 62 (n) 31 (n) McMahon (RCT) -1% 1.01 [0.34-3.03] oxygen 6/99 6/100 McMahon (RCT) -56% 1.56 [0.71-3.43] hosp. 14/99 9/99 PRESECO Golan (DB RCT) 67% 0.33 [0.01-8.12] death 0/599 1/588 PRESECO Golan (DB RCT) 2% 0.98 [0.43-2.25] progression 11/599 11/588 PRESECO Golan (DB RCT) 7% 0.93 [0.77-1.12] progression 159/599 168/588 PRESECO Golan (DB RCT) 4% 0.96 [0.71-1.29] no recov. 73/599 75/588 PRESECO Golan (DB RCT) 14% 0.86 [0.81-0.91] viral time 140 (n) 132 (n) Bruminhent -227% 3.27 [1.43-7.50] progression n/a n/a Chandiwana (RCT) -13% 1.13 [0.23-5.46] progression 37 (n) 39 (n) CT2 Chandiwana (RCT) -23% 1.23 [0.73-2.08] recov. time 37 (n) 39 (n) CT2 Chandiwana (RCT) -67% 1.67 [0.85-3.23] viral+ 27/37 25/38 CT2 Vaezi (DB RCT) -105% 2.05 [0.40-10.6] hosp. 4/38 2/39 PLATCOV Luvira (RCT) -6% 1.06 [0.93-1.21] viral rate 116 (n) 132 (n) Lokanuwatsatien 14% 0.86 [0.64-1.17] PASC 400 (n) 402 (n) Iwata (DB RCT) -16% 1.16 [0.45-2.21] oxygen 12/43 12/43 Iwata (DB RCT) 19% 0.81 [0.17-2.28] oxygen 5/24 6/22 Iwata (DB RCT) -16% 1.16 [0.74-1.82] viral+ 21/41 19/43 Iwata (DB RCT) 6% 0.94 [0.69-1.28] viral+ 26/41 29/43 Iwata (DB RCT) 1% 0.99 [0.82-1.20] viral+ 34/41 36/43 Iwata (DB RCT) 6% 0.94 [0.82-1.09] viral+ 36/41 40/43 Cai 69% 0.31 [0.10-0.96] pneumonia 35 (n) 45 (n) Cai 71% 0.29 [0.10-0.86] viral+ 35 (n) 45 (n) Ivashchenko (RCT) -300% 4.00 [0.20-79.6] death 2/40 0/20 Ivashchenko (RCT) -300% 4.00 [0.20-79.6] ventilation 2/40 0/20 Ivashchenko (RCT) -300% 4.00 [0.20-79.6] ICU 2/40 0/20 Ivashchenko (RCT) 46% 0.54 [0.33-0.88] viral+ 15/40 14/20 Ivashchenko (RCT) 62% 0.38 [0.09-1.52] viral+ 3/40 4/20 Ivashchenko (RCT) -67% 1.67 [0.52-5.39] no disch. 10/40 3/20 Lou (RCT) -422% 5.22 [0.28-96.2] ICU 2/9 0/10 Lou (RCT) 11% 0.89 [0.34-2.32] no recov. 4/9 5/10 Lou (RCT) 14% 0.86 [0.58-1.30] no recov. 7/9 9/10 Lou (RCT) -422% 5.22 [0.28-96.2] viral+ 2/9 0/10 Lou (RCT) -11% 1.11 [0.47-2.60] viral+ 5/9 5/10 Pushkar (RCT) 14% 0.86 [0.73-1.00] no recov. 73/100 85/100 Pushkar (RCT) 33% 0.67 [0.54-0.82] recov. time 100 (n) 100 (n) Pushkar (RCT) 45% 0.55 [0.42-0.72] no recov. 40/100 73/100 Pushkar (RCT) 20% 0.80 [0.64-1.00] recov. time 100 (n) 100 (n) Pushkar (RCT) 70% 0.30 [0.16-0.58] no disch. 10/100 33/100 Pushkar (RCT) 27% 0.73 [0.63-0.86] no recov. 66/100 90/100 Pushkar (RCT) 33% 0.67 [0.50-0.89] pneumonia 40/100 60/100 Pushkar (RCT) 90% 0.10 [0.02-0.40] viral+ 2/100 21/100 Khamis (RCT) 15% 0.85 [0.28-2.59] death 5/44 6/45 OT1 CT2 Khamis (RCT) -2% 1.02 [0.42-2.48] ICU 8/44 8/45 OT1 CT2 Khamis (RCT) -10% 1.10 [0.60-1.99] no recov. 15/44 14/45 OT1 CT2 Solaymani.. (RCT) -19% 1.19 [0.70-2.04] death 26/190 21/183 OT1 Solaymani.. (RCT) -53% 1.53 [0.86-2.71] ventilation 27/190 17/183 OT1 Solaymani.. (RCT) -19% 1.19 [0.73-1.94] ICU 31/190 25/183 OT1 Zhao (RCT) 59% 0.41 [0.16-1.03] viral+ 7/36 9/19 Zhao (RCT) 52% 0.48 [0.25-0.91] viral time 36 (n) 19 (n) Haji Aghajani 26% 0.74 [0.43-1.27] death 40 (n) 951 (n) Alamer -56% 1.56 [0.73-3.36] death 12/233 21/223 Alamer 90% 0.10 [0.04-0.29] ventilation 4/218 27/165 Alamer 49% 0.51 [0.41-0.64] no disch. 221 (n) 201 (n) Almoosa -42% 1.42 [0.90-2.25] death 33/110 24/116 Almoosa -149% 2.49 [1.29-4.80] death 26/110 11/116 Almoosa 62% 0.38 [0.13-1.17] death 4/110 11/116 Almoosa -90% 1.90 [1.11-3.26] ICU 110 (n) 116 (n) Almoosa -11% 1.11 [0.96-1.29] recov. time 110 (n) 116 (n) Shinkai (SB RCT) 37% 0.63 [0.40-0.98] imp. time 107 (n) 49 (n) Shinkai (SB RCT) 59% 0.41 [0.18-0.93] imp. time 47 (n) 13 (n) Assiri (ICU) -79% 1.79 [0.33-8.02] death 11/67 3/51 ICU patients Kulzhanova 88% 0.12 [0.04-0.37] no improv. 3/40 25/40 Kulzhanova 89% 0.11 [0.01-2.00] no improv. 0/40 4/40 Kulzhanova 50% 0.50 [0.21-1.20] viral+ 6/40 12/40 Chen (RCT) -3% 1.03 [0.15-7.22] ICU 2/116 2/120 OT1 Chen (RCT) 74% 0.26 [0.03-2.28] resp. failure 1/116 4/120 OT1 Chen (RCT) 20% 0.80 [0.48-1.34] oxygen 21/116 27/120 OT1 Chen (RCT) 70% 0.30 [0.10-0.87] dyspnea 4/116 14/120 OT1 Chen (RCT) 10% 0.90 [0.45-1.80] dyspnea 13/116 15/120 OT1 Chen (RCT) 20% 0.80 [0.60-1.08] no recov. 45/116 58/120 OT1 Alotaibi 57% 0.43 [0.18-1.01] death 244 (n) 193 (n) OT1 Tabarsi (RCT) 30% 0.70 [0.17-2.88] death 3/32 4/30 OT1 Tabarsi (RCT) 41% 0.59 [0.22-1.59] ICU 5/32 8/30 OT1 Tabarsi (RCT) 6% 0.94 [0.72-1.23] CT imp. 24/32 24/30 OT1 Tabarsi (RCT) 25% 0.75 [0.58-0.97] hosp. time 32 (n) 30 (n) OT1 FIGHT-COVID-19 Atipornwa.. (RCT) 23% 0.77 [0.35-1.67] death 10/100 13/100 OT1 CT2 FIGHT-COVID-19 Atipornwa.. (RCT) 60% 0.40 [0.20-0.79] progression 10/100 25/100 OT1 CT2 FIGHT-COVID-19 Atipornwa.. (RCT) 9% 0.91 [0.73-1.14] viral time 50 (n) 50 (n) OT1 CT2 FIGHT-COVID-19 Atipornwa.. (RCT) 9% 0.91 [0.75-1.10] viral time 50 (n) 50 (n) OT1 CT2 Damayanti 54% 0.46 [0.22-0.92] no recov. 96 (n) 96 (n) Shenoy (DB RCT) -29% 1.29 [0.60-2.77] death 14/175 11/178 Shenoy (DB RCT) -33% 1.33 [0.67-2.66] ventilation 17/175 13/178 Shenoy (DB RCT) -2% 1.02 [0.57-1.82] ICU 20/175 20/178 Shenoy (DB RCT) -1% 1.01 [0.78-1.30] no recov. 157 (n) 158 (n) Shenoy (DB RCT) 6% 0.94 [0.75-1.18] no recov. 175 (n) 178 (n) Shenoy (DB RCT) 17% 0.83 [0.58-1.18] no recov. 157 (n) 158 (n) Shenoy (DB RCT) 32% 0.68 [0.50-0.93] no recov. 175 (n) 178 (n) Chuah (RCT) -1154% 12.54 [0.76-208] death 5/250 0/250 Chuah (RCT) -20% 1.20 [0.36-3.97] ventilation 6/250 5/250 Chuah (RCT) -9% 1.09 [0.49-2.31] ICU 13/250 12/250 Finberg (RCT) -200% 3.00 [0.13-70.3] death 1/25 0/25 Finberg (RCT) -200% 3.00 [0.13-70.3] ventilation 1/25 0/25 Finberg (RCT) 58% 0.42 [0.16-1.10] no recov. 25 (n) 25 (n) Finberg (RCT) -46% 1.46 [0.45-4.81] no recov. 25 (n) 25 (n) Finberg (RCT) 47% 0.53 [0.29-0.98] viral time 25 (n) 25 (n) Al Mutair (ICU) 7% 0.93 [0.77-1.12] death 119/269 128/269 ICU patients OT1 Al Mutair (ICU) -9% 1.09 [0.82-1.43] ARDS 76/269 70/269 ICU patients OT1 Al Mutair (ICU) -34% 1.34 [1.13-1.59] ICU 269 (n) 269 (n) ICU patients OT1 Al Mutair (ICU) -37% 1.37 [1.14-1.64] hosp. time 269 (n) 269 (n) ICU patients OT1 Kurniyanto 48% 0.52 [0.22-1.25] death 10/325 9/152 Cilli 38% 0.62 [0.24-1.63] death 5/23 8/23 Al-Muhsen -263% 3.63 [1.06-12.4] death 156 (n) 442 (n) Al-Muhsen 41% 0.59 [0.47-0.75] oxygen 52/156 248/442 Al-Muhsen -40% 1.40 [1.03-1.91] hosp. time 156 (n) 442 (n) Yulia 85% 0.15 [0.02-1.02] death 432 (all patients) Uyaroğlu (PSM) 67% 0.33 [0.01-7.96] death 0/42 1/42 OT1 Uyaroğlu (PSM) -200% 3.00 [0.13-71.6] ICU 1/42 0/42 OT1 Uyaroğlu (PSM) -11% 1.11 [0.24-5.08] hosp. time 42 (n) 42 (n) OT1 AlQahtani (RCT) -196% 2.96 [0.12-71.1] death 1/54 0/52 AlQahtani (RCT) 76% 0.24 [0.03-2.08] ICU 1/54 4/52 AlQahtani (RCT) -42% 1.42 [0.50-4.04] no recov. 8/53 5/47 AlQahtani (RCT) 43% 0.57 [0.27-1.21] viral+ 8/40 14/40 Shinada 7% 0.93 [0.45-1.89] hosp. 17 (n) 17 (n) Shinada 55% 0.45 [0.21-0.96] viral+ 17 (n) 17 (n) Hassaniazad (RCT) 68% 0.32 [0.07-1.48] death 2/32 6/31 OT1 Hassaniazad (RCT) 3% 0.97 [0.06-14.8] death 1/32 1/31 OT1 Hassaniazad (RCT) 35% 0.65 [0.20-2.07] ICU 4/32 6/31 OT1 Hassaniazad (RCT) 25% 0.75 [0.51-1.10] hosp. time 32 (n) 31 (n) OT1 Hassaniazad (RCT) 18% 0.82 [0.62-1.08] viral+ 22/32 26/31 OT1 Hafez -3% 1.03 [0.68-1.56] viral+ 59 (n) 1,446 (n) CT2 Hafez 59% 0.41 [0.15-1.15] viral+ 4 (n) 1,446 (n) CT2 Rahman (DB RCT) 89% 0.11 [0.01-0.75] no improv. 1/19 8/16 Rahman (DB RCT) 65% 0.35 [0.16-0.78] no improv. 5/19 12/16 Rahman (DB RCT) 47% 0.53 [0.34-0.81] no improv. 10/19 16/16 Rahman (DB RCT) 92% 0.08 [0.01-0.59] viral+ 1/25 12/25 Rahman (DB RCT) 62% 0.38 [0.18-0.80] viral+ 6/25 16/25 Rahman (DB RCT) 48% 0.52 [0.36-0.76] viral+ 13/25 25/25 Tehrani (RCT) 34% 0.66 [0.34-1.26] hosp. 10/38 16/40 Tehrani (RCT) 80% 0.20 [0.01-4.12] no recov. 0/38 2/40 Tehrani (RCT) 58% 0.42 [0.21-0.84] no recov. 8/38 20/40 Tehrani (RCT) 47% 0.53 [0.05-5.57] no recov. 1/38 2/40 Tehrani (RCT) 47% 0.53 [0.20-1.40] no recov. 5/38 10/40 Tehrani (RCT) 66% 0.34 [0.01-8.07] no recov. 0/38 1/40 Tehrani (RCT) 47% 0.53 [0.10-2.71] no recov. 2/38 4/40 Tehrani (RCT) 30% 0.70 [0.45-1.10] no recov. 16/38 24/40 Tehrani (RCT) 7% 0.93 [0.75-1.15] no recov. 30/38 34/40 Tehrani (RCT) 21% 0.79 [0.30-2.06] no recov. 6/38 8/40 Tehrani (RCT) 38% 0.62 [0.33-1.18] no recov. 10/38 17/40 Abdulrahman (ICU) 3% 0.97 [0.81-1.18] death 74/193 593/1,506 ICU patients Acar Sevinc (ICU) 16% 0.84 [0.62-1.12] death 57/85 12/15 ICU patients OT1 Acar Sevinc (ICU) 10% 0.90 [0.67-1.19] ventilation 61/85 12/15 ICU patients OT1 Tawfik 96% 0.04 [0.00-0.26] death 1/103 17/62 Tawfik 21% 0.79 [0.45-1.40] ICU 21/103 16/62 Tawfik 16% 0.84 [0.80-0.88] hosp. time 102 (n) 58 (n) Babayigit -184% 2.84 [1.27-6.14] ventilation 47/325 17/977 Babayigit -181% 2.81 [1.66-4.62] ICU 75/325 35/969 Babayigit -100% 2.00 [1.33-3.02] hosp. time 265 (n) 746 (n) Behboodikhah 68% 0.32 [0.05-1.83] death 95 (n) 2,079 (n) PIONEER Shah (RCT) 26% 0.74 [0.44-1.23] death 26/251 34/248 PIONEER Shah (RCT) 24% 0.76 [0.49-1.16] ventilation 251 (n) 248 (n) PIONEER Shah (RCT) 6% 0.94 [0.79-1.12] no recov. 251 (n) 248 (n) Alosaimi (PSM) 80% 0.20 [0.01-4.03] death 0/37 2/37 OT1 Alosaimi (PSM) -75% 1.75 [0.20-15.6] hosp. time 37 (n) 37 (n) OT1 Alosaimi (PSM) -40% 1.40 [0.21-9.26] no disch. 37 (n) 37 (n) OT1 Delen 23% 0.77 [0.19-3.20] ICU 3/34 4/35 Delen 88% 0.12 [0.02-0.91] no recov. 1/21 8/21 Delen -2% 1.02 [0.90-1.16] hosp. time 34 (n) 35 (n) Delen -3% 1.03 [0.88-1.21] no disch. 31/34 31/35 Hartantri 76% 0.24 [0.11-0.54] death n/a n/a Hartantri 60% 0.40 [0.17-0.98] death n/a n/a Alshamrani (PSM) -14% 1.14 [0.96-1.35] death 326/1,159 316/1,380 Alshamrani (PSM) -2% 1.02 [0.86-1.20] progression 475/1,159 499/1,380 Alshamrani (PSM) -19% 1.19 [1.05-1.34] ICU 668 (n) 633 (n) Alshamrani (PSM) -29% 1.29 [1.11-1.50] hosp. time 1,159 (n) 1,380 (n) Arfijanto 51% 0.49 [0.26-0.94] viral+ 8/37 55/125 Sulaiman (ICU) -17% 1.17 [0.73-1.87] death 73 (n) 73 (n) ICU patients Sulaiman (ICU) 14% 0.86 [0.53-1.39] death 73 (n) 73 (n) ICU patients Sulaiman (ICU) -47% 1.47 [1.11-1.95] ventilation time 73 (n) 73 (n) ICU patients Sulaiman (ICU) -50% 1.50 [1.10-2.04] ICU 73 (n) 73 (n) ICU patients Shamsi 96% 0.04 [0.00-3.01] death 0/19 24/164 FAVID Horcajada (DB RCT) -383% 4.83 [0.24-95.1] death 2/23 0/21 FAVID Horcajada (DB RCT) -37% 1.37 [0.25-7.41] ventilation 3/23 2/21 FAVID Horcajada (DB RCT) 17% 0.83 [0.40-1.74] recov. time 23 (n) 21 (n) FAVID Horcajada (DB RCT) -125% 2.25 [0.21-23.7] viral time 23 (n) 21 (n) Alsaraj (RCT) -87% 1.87 [0.67-5.21] death 9/51 5/53 Saito -168% 2.68 [0.96-7.48] death 7/40 6/92 PRINCIPLE Hobbs (RCT) 86% 0.14 [0.01-2.65] death 0/1,829 3/1,668 PRINCIPLE Hobbs (RCT) -191% 2.91 [0.12-71.4] ICU 1/1,825 0/1,663 PRINCIPLE Hobbs (RCT) 1% 0.99 [0.61-1.61] death/hosp. 1,829 (n) 3,256 (n) PRINCIPLE Hobbs (RCT) 17% 0.83 [0.73-0.94] no recov. 350/1,582 378/1,412 PRINCIPLE Hobbs (RCT) 12% 0.88 [0.78-0.99] no recov. 378/1,503 384/1,340 PRINCIPLE Hobbs (RCT) 17% 0.83 [0.74-0.92] no recov. 418/1,507 459/1,370 PRINCIPLE Hobbs (RCT) 29% 0.71 [0.53-0.95] no recov. 1,829 (n) 1,668 (n) PRINCIPLE Hobbs (RCT) 19% 0.81 [0.75-0.88] no recov. 1,829 (n) 3,256 (n) PRINCIPLE Hobbs (RCT) 34% 0.66 [0.58-0.75] no recov. 1,828 (n) 1,666 (n) PRINCIPLE Hobbs (RCT) 25% 0.75 [0.69-0.83] no recov. 1,829 (n) 1,668 (n) PRINCIPLE Hobbs (RCT) 12% 0.88 [0.81-0.94] no recov. 1,562 (n) 1,407 (n) PRINCIPLE Hobbs (RCT) 21% 0.79 [0.73-0.86] no recov. 1,562 (n) 1,407 (n) PRINCIPLE Hobbs (RCT) 23% 0.77 [0.72-0.83] no recov. 1,828 (n) 1,667 (n) Favipiravir COVID-19 outcomes c19 earlyNovember 2024 1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors favipiravir Favors control
Figure S2. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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