Efficacy and safety of remdesivir and favipiravir in COVID-19 patients - A systematic review and meta-analysis.

Coronavirus-2019 (Covid-19) has led to a severe medical, social and economic crisis globally. The use of antivirals has given inconsistent results; thus, systematic summaries of available evidence may help us to understand its effectiveness. The current investigation was planned to conduct a systematic review and meta-analysis on the use of antivirals for Covid-19. Using 'MeSH' term databases were searched on Google Scholar, PubMed, Web of Science, SCOPUS, OVID, Cochrane Library, and Limits- English Language only. Title/abstract screening, full-text screening and data extraction were carried out by three authors. Pooled effect sizes and 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method of random effects for meta-analysis. Ten studies were found eligible for inclusion: randomized controlled trials Moderate-quality evidence suggests a likely clinical benefit from the use of remdesivir in improving the number of recoveries (OR 1.46; 95% CI 1.23-1.74; I2=0%). A possibility of a higher mortality rate is also suggested by high-quality evidence with remdesivir (OR 0.78; 95% CI 0.57-1.05, I2=14%). Favipiravir also showed patient's higher mortality outcome (OR 0.69;95% CI 0.24-2.01, I2 = 0%). Although the need for oxygen therapy (OR 0.70 95% CI 0.40-1.23; I2= 72%) was highly significant p < 0.001** and Remdesivir/Favipiravir was determined to be beneficial overall for male gender data across all studies (OR 0.77; 95% CI;0.37-1.60;I2=90%) and highly significant < 0.0001***. Worsening of comorbidities (OR 0.94; 95% CI 0.81-1.08; I2= 0%), Ferritin level measured (OR-19.80 95% CI -56.51-16.92; I2 = 0 %) and Transferred to ICU/ Mechanical Ventilation (OR 0.85 95% CI 0.25 -2.91; I2 = 52 %) were observed in both the anti-viral. This meta-analysis found mixed efficacy for Remdesivir and negative outcomes for Favipiravir.