The COVID-19 causing coronavirus is an enveloped RNA virus that utilizes an enzyme RNA dependent RNA polymerase for its replication. Favipiravir (FVP) triphosphate, a purine nucleoside analog, inhibits that enzyme. We have conducted this systematic review and meta-analysis on efficacy and safety of the drug FVP as a treatment for COVID-19. Databases like Pubmed, Pubmed Central, Scopus, Embase, Google Scholar, preprint sites, and clinicaltirals.gov were searched. The studies with the standard of care (SOC) and FVP as a treatment drug were considered as the treatment group and the SOC with other antivirals and supportive care as the control group. Quantitative synthesis was done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirements were studied. We identified a total of 1798 studies after searching the electronic databases. Nine in the qualitative studies and four studies in the quantitative synthesis met the criteria. There was a significant clinical improvement in the FVP group on the 14th day compared to the control group (RR 1.29, 1.08–1.54). Clinical deterioration rates were less likely in the FVP group though statistically not significant (OR 0.59, 95% CI 0.30–1.14) at the endpoint of study (7–15 days). The meta-analysis showed no significant differences between the two groups on viral clearance (day 14: RR 1.06, 95% CI 0.84–1.33), non-invasive ventilation or oxygen requirement (OR 0.76, 95% CI 0.42–1.39), and adverse effects (OR 0.69, 0.13–3.57). There are 31 randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment. There is a significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on viral clearance, oxygen support requirement and side effect profiles.

中文翻译：

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法匹拉韦与其他抗病毒药物或治疗 COVID-19 的护理标准相比：快速系统评价和荟萃分析

引起 COVID-19 的冠状病毒是一种有包膜 RNA 病毒，利用依赖于 RNA 的 RNA 聚合酶进行复制。法匹拉韦 (FVP) 三磷酸是一种嘌呤核苷类似物，可抑制该酶。我们对 FVP 药物治疗 COVID-19 的功效和安全性进行了系统评价和荟萃分析。检索了 Pubmed、Pubmed Central、Scopus、Embase、Google Scholar、预印本网站和 Clinicaltirals.gov 等数据库。以标准治疗（SOC）和FVP作为治疗药物的研究被认为是治疗组，而SOC与其他抗病毒药物和支持治疗的研究被认为是对照组。使用 RevMan 5.4 进行定量合成。研究了临床改善、逆转录聚合酶链反应（RT-PCR）转阴、不良反应和需氧量。在搜索电子数据库后，我们总共确定了 1798 项研究。九项定性研究和四项定量综合研究符合标准。与对照组相比，FVP 组在第 14 天有显着的临床改善（RR 1.29，1.08-1.54）。FVP 组的临床恶化率不太可能，但在研究终点（7-15 天）统计上不显着（OR 0.59，95% CI 0.30-1.14）。荟萃分析显示，两组在病毒清除率（第 14 天：RR 1.06，95% CI 0.84–1.33）、无创通气或需氧量（OR 0.76，95% CI 0.42–1.39）和不良反应（OR 0.69，0.13–3.57）。在世界不同地区注册了 31 项随机对照试验 (RCT)，重点关注 FVP 用于 COVID-19 的治疗。与标准治疗相比，FVP 治疗后临床和放射学方面有显着改善，病毒清除、氧气支持需求和副作用特征没有显着差异。