Supplementary Data — Favipiravir for COVID-19: real-time meta-analysis of 74 studies

October 2026

Favipiravir COVID-19 outcomes

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk
Ruzhentsova (RCT)6%0.94 · 0.78–1.14hosp.3/1122/56 Ruzhentsova (RCT)39%0.61 · 0.43–0.88no recov.112 (n)56 (n) Ruzhentsova (RCT)22%0.78 · 0.92–1.79viral+112 (n)56 (n) Udwadia (RCT)66%0.34 · 0.01–8.12death0/731/75 Udwadia (RCT)29%0.71 · 0.49–1.03no recov.75 (n)72 (n) Udwadia (RCT)43%0.57 · 0.36–0.91no recov.75 (n)72 (n) Udwadia (RCT)27%0.73 · 0.51–1.06viral time75 (n)72 (n) Sawanpanyalert68%0.32 · 0.15–0.66progressionn/an/a Holubar (DB RCT)89%0.11 · 0.01–2.02hosp.0/754/74 Holubar (DB RCT)30%0.70 · 0.23–2.12ER visit5/757/74 Holubar (DB RCT)−19%1.19 · 0.78–1.85no recov.65 (n)70 (n) Holubar (DB RCT)−32%1.32 · 0.83–2.08viral+59 (n)57 (n) Alattar (PSM)33%0.67 · 0.28–1.61death8/38712/387 Alattar (PSM)−2%1.02 · 0.90–1.16no recov.26/38728/387 Alattar (PSM)−6%1.06 · 0.99–1.14recov. time387 (n)387 (n) Alattar (PSM)44%0.56 · 0.44–0.71viral+78/387139/387 Bosaeed (DB RCT)−619%7.19 · 0.38–138ICU3/1120/119 Bosaeed (DB RCT)−219%3.19 · 0.66–15.47hosp.6/1122/119 Bosaeed (DB RCT)−12%1.12 · 0.80–1.56no recov.112 (n)119 (n) Bosaeed (DB RCT)−15%1.15 · 0.75–1.75viral+112 (n)119 (n) Lowe (DB RCT)−202%3.02 · 0.13–72.60ICU1/590/60FLARE Lowe (DB RCT)−202%3.02 · 0.13–72.60hosp.1/590/60FLARE Lowe (DB RCT)28%0.72 · 0.44–0.98viral+29/5438/52FLARE Adhikari (RCT)−40%1.40 · 0.57–3.44no improv.10/386/32 Adhikari (RCT)−36%1.36 · 0.52–3.59no improv.8/275/23 Adhikari (RCT)−64%1.64 · 0.18–15.26no improv.2/111/9 Tsuzuki13%0.87 · 0.52–1.46death2,532 (n)5,122 (n) Tsuzuki−2%1.02 · 0.65–1.60ventilation2,532 (n)5,122 (n) Tsuzuki18%0.82 · 0.66–1.04progression2,532 (n)5,122 (n) Qadir97%0.03 · 0.00–0.47death0/12517/125 Qadir60%0.40 · 0.23–0.71hosp.14/12535/125 Qadir97%0.03 · 0.00–0.47no recov.0/12517/125 Qadir71%0.29 · 0.17–0.50no recov.14/12548/125 Qadir79%0.21 · 0.13–0.36no recov.14/12566/125 Qadir71%0.29 · 0.22–0.40no recov.32/125109/125 Qadir58%0.42 · 0.25–0.70recov. time125 (n)125 (n) Usanma Koban86%0.14 · 0.02–0.70viral+47 (n)79 (n) Sirijatuphat (RCT)64%0.36 · 0.20–0.64improv.62 (n)31 (n) Sirijatuphat (RCT)90%0.10 · 0.03–0.39improv.62 (n)31 (n) Sirijatuphat (RCT)43%0.57 · 0.23–1.43progression8/627/31 Sirijatuphat (RCT)−4%1.04 · 0.63–1.72viral+62 (n)31 (n) McMahon (RCT)−1%1.01 · 0.34–3.03oxygen6/996/100 McMahon (RCT)−56%1.56 · 0.71–3.43hosp.14/999/99 Golan (DB RCT)67%0.33 · 0.01–8.12death0/5991/588PRESECO Golan (DB RCT)2%0.98 · 0.43–2.25progression11/59911/588PRESECO Golan (DB RCT)7%0.93 · 0.77–1.12progression159/599168/588PRESECO Golan (DB RCT)4%0.96 · 0.71–1.29no recov.73/59975/588PRESECO Golan (DB RCT)14%0.86 · 0.81–0.91viral time140 (n)132 (n)PRESECO Bruminhent−227%3.27 · 1.43–7.50progressionn/an/a Chandiwana (RCT)−13%1.13 · 0.23–5.46progression37 (n)39 (n)CT2 Chandiwana (RCT)−23%1.23 · 0.73–2.08recov. time37 (n)39 (n)CT2 Chandiwana (RCT)−67%1.67 · 0.85–3.23viral+27/3725/38CT2 Vaezi (DB RCT)−105%2.05 · 0.40–10.56hosp.4/382/39 Luvira (RCT)−6%1.06 · 0.93–1.21viral rate116 (n)132 (n)PLATCOV Lokanuwatsatien14%0.86 · 0.64–1.17PASC400 (n)402 (n) Iwata (DB RCT)−16%1.16 · 0.45–2.21oxygen12/4312/43 Iwata (DB RCT)19%0.81 · 0.17–2.28oxygen5/246/22 Iwata (DB RCT)−16%1.16 · 0.74–1.82viral+21/4119/43 Iwata (DB RCT)6%0.94 · 0.69–1.28viral+26/4129/43 Iwata (DB RCT)1%0.99 · 0.82–1.20viral+34/4136/43 Iwata (DB RCT)6%0.94 · 0.82–1.09viral+36/4140/43 Siripongboonsitti25%0.75 · 0.51–0.97transmission1,064/1,836122/170FaviPrev Tate (RCT)34%0.66 · 0.11–3.88hosp.2/1523/150GETAFIX Tate (RCT)21%0.79 · 0.34–1.897-point status152 (n)150 (n)GETAFIX Tate (RCT)3%0.97 · 0.76–1.23no recov.152 (n)150 (n)GETAFIX Tate (RCT)12%0.88 · 0.51–1.54viral+152 (n)150 (n)GETAFIX Cai69%0.31 · 0.10–0.96pneumonia35 (n)45 (n) Cai71%0.29 · 0.10–0.86viral+35 (n)45 (n) Ivashchenko (RCT)−300%4.00 · 0.20–79.58death2/400/20 Ivashchenko (RCT)−300%4.00 · 0.20–79.58ventilation2/400/20 Ivashchenko (RCT)−300%4.00 · 0.20–79.58ICU2/400/20 Ivashchenko (RCT)46%0.54 · 0.33–0.88viral+15/4014/20 Ivashchenko (RCT)62%0.38 · 0.09–1.52viral+3/404/20 Ivashchenko (RCT)−67%1.67 · 0.52–5.39no disch.10/403/20 Lou (RCT)−422%5.22 · 0.28–96.17ICU2/90/10 Lou (RCT)11%0.89 · 0.34–2.32no recov.4/95/10 Lou (RCT)14%0.86 · 0.58–1.30no recov.7/99/10 Lou (RCT)−422%5.22 · 0.28–96.17viral+2/90/10 Lou (RCT)−11%1.11 · 0.47–2.60viral+5/95/10 Pushkar (RCT)14%0.86 · 0.74–0.99no recov.73/10085/100 Pushkar (RCT)33%0.67 · 0.54–0.82recov. time100 (n)100 (n) Pushkar (RCT)45%0.55 · 0.42–0.72no recov.40/10073/100 Pushkar (RCT)20%0.80 · 0.64–1.00recov. time100 (n)100 (n) Pushkar (RCT)70%0.30 · 0.16–0.58no disch.10/10033/100 Pushkar (RCT)27%0.73 · 0.63–0.86no recov.66/10090/100 Pushkar (RCT)33%0.67 · 0.50–0.89pneumonia40/10060/100 Pushkar (RCT)90%0.10 · 0.02–0.40viral+2/10021/100 Khamis (RCT)15%0.85 · 0.28–2.59death5/446/45OT1 CT2 Khamis (RCT)−2%1.02 · 0.42–2.48ICU8/448/45OT1 CT2 Khamis (RCT)−10%1.10 · 0.60–1.99no recov.15/4414/45OT1 CT2 Solaymani.. (RCT)−19%1.19 · 0.70–2.04death26/19021/183OT1 Solaymani.. (RCT)−53%1.53 · 0.86–2.71ventilation27/19017/183OT1 Solaymani.. (RCT)−19%1.19 · 0.73–1.94ICU31/19025/183OT1 Zhao (RCT)59%0.41 · 0.18–0.93viral+7/369/19 Zhao (RCT)52%0.48 · 0.25–0.91viral time36 (n)19 (n) Kokturk−84%1.84 · 0.60–5.36death39/32828/1,172 Haji Aghajani26%0.74 · 0.43–1.27death40 (n)951 (n) Alamer−56%1.56 · 0.73–3.36death12/23321/223 Alamer90%0.10 · 0.04–0.29ventilation4/21827/165 Alamer49%0.51 · 0.41–0.64no disch.221 (n)201 (n) Almoosa−42%1.42 · 0.90–2.25death33/11024/116 Almoosa−149%2.49 · 1.29–4.80death26/11011/116 Almoosa62%0.38 · 0.13–1.17death4/11011/116 Almoosa−90%1.90 · 1.11–3.26ICU110 (n)116 (n) Almoosa−11%1.11 · 0.96–1.29recov. time110 (n)116 (n) Shinkai (SB RCT)37%0.63 · 0.40–0.98imp. time107 (n)49 (n) Shinkai (SB RCT)59%0.41 · 0.18–0.93imp. time47 (n)13 (n) Kulzhanova88%0.12 · 0.04–0.37no improv.3/4025/40 Kulzhanova89%0.11 · 0.01–2.00no improv.0/404/40 Kulzhanova50%0.50 · 0.21–1.20viral+6/4012/40 Chen (RCT)−3%1.03 · 0.15–7.22ICU2/1162/120OT1 Chen (RCT)74%0.26 · 0.03–2.28resp. failure1/1164/120OT1 Chen (RCT)20%0.80 · 0.48–1.34oxygen21/11627/120OT1 Chen (RCT)70%0.30 · 0.10–0.87dyspnea4/11614/120OT1 Chen (RCT)10%0.90 · 0.45–1.80dyspnea13/11615/120OT1 Chen (RCT)20%0.80 · 0.60–1.08no recov.45/11658/120OT1 Alotaibi57%0.43 · 0.18–1.01death244 (n)193 (n)OT1 Tabarsi (RCT)30%0.70 · 0.17–2.88death3/324/30OT1 Tabarsi (RCT)41%0.59 · 0.22–1.59ICU5/328/30OT1 Tabarsi (RCT)6%0.94 · 0.72–1.23CT imp.24/3224/30OT1 Tabarsi (RCT)25%0.75 · 0.58–0.97hosp. time32 (n)30 (n)OT1 Damayanti54%0.46 · 0.22–0.92no recov.96 (n)96 (n) Shenoy (DB RCT)−29%1.29 · 0.60–2.77death14/17511/178 Shenoy (DB RCT)−33%1.33 · 0.67–2.66ventilation17/17513/178 Shenoy (DB RCT)−2%1.02 · 0.57–1.82ICU20/17520/178 Shenoy (DB RCT)−1%1.01 · 0.78–1.30no recov.157 (n)158 (n) Shenoy (DB RCT)6%0.94 · 0.75–1.18no recov.175 (n)178 (n) Shenoy (DB RCT)17%0.83 · 0.58–1.18no recov.157 (n)158 (n) Shenoy (DB RCT)32%0.68 · 0.50–0.93no recov.175 (n)178 (n) Chuah (RCT)−1154%12.54 · 0.76–208death5/2500/250 Chuah (RCT)−20%1.20 · 0.36–3.97ventilation6/2505/250 Chuah (RCT)−9%1.09 · 0.49–2.31ICU13/25012/250 Finberg (RCT)−200%3.00 · 0.13–70.30death1/250/25 Finberg (RCT)−200%3.00 · 0.13–70.30ventilation1/250/25 Finberg (RCT)58%0.42 · 0.16–1.10no recov.25 (n)25 (n) Finberg (RCT)−46%1.46 · 0.45–4.81no recov.25 (n)25 (n) Finberg (RCT)47%0.53 · 0.29–0.98viral time25 (n)25 (n) Al Mutair (ICU)7%0.93 · 0.77–1.12death119/269128/269ICU patients OT1 Al Mutair (ICU)−9%1.09 · 0.82–1.43ARDS76/26970/269ICU patients OT1 Al Mutair (ICU)−34%1.34 · 1.13–1.59ICU269 (n)269 (n)ICU patients OT1 Al Mutair (ICU)−37%1.37 · 1.14–1.64hosp. time269 (n)269 (n)ICU patients OT1 Kurniyanto48%0.52 · 0.22–1.25death10/3259/152 Cilli38%0.62 · 0.24–1.63death5/238/23 Al-Muhsen−263%3.63 · 1.06–12.45death156 (n)442 (n) Al-Muhsen41%0.59 · 0.47–0.75oxygen52/156248/442 Al-Muhsen−40%1.40 · 1.03–1.91hosp. time156 (n)442 (n) Yulia85%0.15 · 0.02–1.02death432 (all patients) Uyaroğlu (PSM)67%0.33 · 0.01–7.96death0/421/42OT1 Uyaroğlu (PSM)−200%3.00 · 0.13–71.61ICU1/420/42OT1 Uyaroğlu (PSM)−11%1.11 · 0.24–5.08hosp. time42 (n)42 (n)OT1 AlQahtani (RCT)−196%2.96 · 0.12–71.13death1/540/52 AlQahtani (RCT)76%0.24 · 0.03–2.08ICU1/544/52 AlQahtani (RCT)−42%1.42 · 0.50–4.04no recov.8/535/47 AlQahtani (RCT)43%0.57 · 0.27–1.21viral+8/4014/40 Shinada7%0.93 · 0.45–1.89hosp.17 (n)17 (n) Shinada55%0.45 · 0.21–0.96viral+17 (n)17 (n) Hassaniazad (RCT)68%0.32 · 0.07–1.48death2/326/31OT1 Hassaniazad (RCT)3%0.97 · 0.06–14.82death1/321/31OT1 Hassaniazad (RCT)35%0.65 · 0.20–2.07ICU4/326/31OT1 Hassaniazad (RCT)25%0.75 · 0.51–1.10hosp. time32 (n)31 (n)OT1 Hassaniazad (RCT)18%0.82 · 0.62–1.08viral+22/3226/31OT1 Hafez−3%1.03 · 0.68–1.56viral+59 (n)1,446 (n)CT2 Hafez59%0.41 · 0.15–1.15viral+4 (n)1,446 (n)CT2 Rahman (DB RCT)89%0.11 · 0.01–0.75no improv.1/198/16 Rahman (DB RCT)65%0.35 · 0.16–0.78no improv.5/1912/16 Rahman (DB RCT)47%0.53 · 0.34–0.81no improv.10/1916/16 Rahman (DB RCT)92%0.08 · 0.01–0.59viral+1/2512/25 Rahman (DB RCT)62%0.38 · 0.18–0.80viral+6/2516/25 Rahman (DB RCT)48%0.52 · 0.36–0.76viral+13/2525/25 Tehrani (RCT)34%0.66 · 0.34–1.26hosp.10/3816/40 Tehrani (RCT)80%0.20 · 0.01–4.12no recov.0/382/40 Tehrani (RCT)58%0.42 · 0.21–0.84no recov.8/3820/40 Tehrani (RCT)47%0.53 · 0.05–5.57no recov.1/382/40 Tehrani (RCT)47%0.53 · 0.20–1.40no recov.5/3810/40 Tehrani (RCT)66%0.34 · 0.01–8.07no recov.0/381/40 Tehrani (RCT)47%0.53 · 0.10–2.71no recov.2/384/40 Tehrani (RCT)30%0.70 · 0.45–1.10no recov.16/3824/40 Tehrani (RCT)7%0.93 · 0.75–1.15no recov.30/3834/40 Tehrani (RCT)21%0.79 · 0.30–2.06no recov.6/388/40 Tehrani (RCT)38%0.62 · 0.33–1.18no recov.10/3817/40 Abdulrahman (ICU)3%0.97 · 0.81–1.18death74/193593/1,506ICU patients Acar Sevinc (ICU)16%0.84 · 0.62–1.12death57/8512/15ICU patients OT1 Acar Sevinc (ICU)10%0.90 · 0.67–1.19ventilation61/8512/15ICU patients OT1 Tawfik96%0.04 · 0.00–0.26death1/10317/62 Tawfik21%0.79 · 0.45–1.40ICU21/10316/62 Tawfik16%0.84 · 0.80–0.88hosp. time102 (n)58 (n) Babayigit−184%2.84 · 1.27–6.14ventilation47/32517/977 Babayigit−181%2.81 · 1.66–4.62ICU75/32535/969 Babayigit−100%2.00 · 1.33–3.02hosp. time265 (n)746 (n) Behboodikhah68%0.32 · 0.05–1.83death95 (n)2,079 (n) Shah (RCT)26%0.74 · 0.44–1.23death26/25134/248PIONEER Shah (RCT)24%0.76 · 0.49–1.16ventilation251 (n)248 (n)PIONEER Shah (RCT)6%0.94 · 0.79–1.12no recov.251 (n)248 (n)PIONEER Alosaimi (PSM)80%0.20 · 0.01–4.03death0/372/37OT1 Alosaimi (PSM)−75%1.75 · 0.20–15.63hosp. time37 (n)37 (n)OT1 Alosaimi (PSM)−40%1.40 · 0.21–9.26no disch.37 (n)37 (n)OT1 Delen23%0.77 · 0.19–3.20ICU3/344/35 Delen88%0.12 · 0.02–0.91no recov.1/218/21 Delen−2%1.02 · 0.90–1.16hosp. time34 (n)35 (n) Delen−3%1.03 · 0.88–1.21no disch.31/3431/35 Hartantri76%0.24 · 0.11–0.54deathn/an/a Hartantri60%0.40 · 0.17–0.98deathn/an/a Alshamrani (PSM)−14%1.14 · 0.96–1.35death326/1,159316/1,380 Alshamrani (PSM)−2%1.02 · 0.86–1.20progression475/1,159499/1,380 Alshamrani (PSM)−19%1.19 · 1.05–1.34ICU668 (n)633 (n) Alshamrani (PSM)−29%1.29 · 1.11–1.50hosp. time1,159 (n)1,380 (n) Arfijanto51%0.49 · 0.26–0.94viral+8/3755/125 Sulaiman (ICU)−17%1.17 · 0.73–1.87death73 (n)73 (n)ICU patients Sulaiman (ICU)14%0.86 · 0.53–1.39death73 (n)73 (n)ICU patients Sulaiman (ICU)−47%1.47 · 1.11–1.95ventilation time73 (n)73 (n)ICU patients Sulaiman (ICU)−50%1.50 · 1.10–2.04ICU73 (n)73 (n)ICU patients Shamsi96%0.04 · 0.00–0.57death0/1924/164 Horcajada (DB RCT)−383%4.83 · 0.24–95.09death2/230/21FAVID Horcajada (DB RCT)−37%1.37 · 0.25–7.41ventilation3/232/21FAVID Horcajada (DB RCT)17%0.83 · 0.40–1.74recov. time23 (n)21 (n)FAVID Horcajada (DB RCT)−125%2.25 · 0.21–23.72viral time23 (n)21 (n)FAVID Alsaraj (RCT)−87%1.87 · 0.67–5.21death9/515/53 Saito−168%2.68 · 0.96–7.48death7/406/92 Hobbs (RCT)86%0.14 · 0.01–2.65death0/1,8293/1,668PRINCIPLE Hobbs (RCT)−191%2.91 · 0.12–71.42ICU1/1,8250/1,663PRINCIPLE Hobbs (RCT)1%0.99 · 0.61–1.61death/hosp.1,829 (n)3,256 (n)PRINCIPLE Hobbs (RCT)17%0.83 · 0.73–0.94no recov.350/1,582378/1,412PRINCIPLE Hobbs (RCT)12%0.88 · 0.78–0.99no recov.378/1,503384/1,340PRINCIPLE Hobbs (RCT)17%0.83 · 0.74–0.92no recov.418/1,507459/1,370PRINCIPLE Hobbs (RCT)29%0.71 · 0.53–0.95no recov.1,829 (n)1,668 (n)PRINCIPLE Hobbs (RCT)19%0.81 · 0.75–0.88no recov.1,829 (n)3,256 (n)PRINCIPLE Hobbs (RCT)34%0.66 · 0.58–0.75no recov.1,828 (n)1,666 (n)PRINCIPLE Hobbs (RCT)25%0.75 · 0.69–0.83no recov.1,829 (n)1,668 (n)PRINCIPLE Hobbs (RCT)12%0.88 · 0.81–0.94no recov.1,562 (n)1,407 (n)PRINCIPLE Hobbs (RCT)21%0.79 · 0.73–0.86no recov.1,562 (n)1,407 (n)PRINCIPLE Hobbs (RCT)23%0.77 · 0.72–0.83no recov.1,828 (n)1,667 (n)PRINCIPLE Abdulaziz−149%2.49 · 1.12–5.51misc.57 (n)179 (n) Lumkul4%0.96 · 0.93–0.99death828 (n)109 (n) Siripongbo.. (RCT)50%0.50 · 0.16–1.60symp. case4/848/84PEPfavi Siripongbo.. (RCT)36%0.64 · 0.26–1.56cases7/8411/84PEPfavi Siripongbo.. (RCT)45%0.55 · 0.21–1.41cases6/8411/84PEPfavi
00.511.52+
1 OT: comparison with other treatment
2 CT: study uses combined treatment
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← Favipiravir
reduces risk
Favipiravir
increases risk →
Fig. S1. All outcomes.
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Fig. 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.