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Figures & Tables

Figure 1.

Patient flowchart. COVID-19, coronavirus disease 2019; FPV, favipiravir; MIS-C, multisystem inflammatory syndrome in children.

Figure 2.

Simulations of FPV plasma PK in Thai children and adolescents weighing 3 kg, 5 kg, 8 kg, 10 kg, 20 kg, and 35 kg. PK parameter values at these weights were derived from allometric scaling of plasma PK observed in Thai adults weighing 60 kg. BID, twice daily; CL, clearance; Ctrough, trough concentration; D, day; EC90, 90% effective concentration; FPV, favipiravir; IP, investigational product; KA, absorption rate constant; PK, pharmacokinetics; Vd, volume of distribution.

Factors associated with fever duration in COVID-19 participants who had a fever at baseline (n = 2,076 participants)

VariablesCoefficient(d)(95% CI)PCoefficient(d)(95% CI)P
Age (years)
  <5Reference
  ≥51.1(0.74, 1.55)<0.001
Biological sex
  MaleReference
  Female0.08(–0.33, 0.49)0.704
Underlying disease–0.03(–0.50, 0.43)0.890
History of COVID-19 vaccination–1.12(–2.39, 0.14)0.082
Predominant strain during infection
  Pre-delta/pre-omicronReference
  Delta–0.38(–1.21,0.46)0.377
  Omicron–3.33(–4.12, –2.55)<0.001–3.02(–3.85, –2.19)<0.001
Clinical severity
  Non-pneumoniaReference
  Pneumonia0.73(0.32, 1.15)0.0010.49(0.07, 0.90)0.022
Treatment
  FPV–3.21(–3.99, –2.44)<0.001–2.66(–3.44, –1.88)<0.001
  Antibiotics1.1(0.30, 1.92)0.008
Time from COVID-19 diagnosis until FPV0.94(0.80, 1.08)<0.001
administration (d)

Laboratory results at FPV treatment initiation and completion for patients with and without COVID-19 pneumonia

COVID-19 non-pneumoniaCOVID-19 pneumonia
Treatment initiationTreatment completionPTreatment initiationTreatment completionP
Hematocrit, median (IQR)36.5 (33.9–38.5)n = 12036.6 (34.1–39)n = 7500.56936.7 (34.8–39.1)n = 5370.493
Anemia90 (75)n = 120519 (69.3)n = 7490.20558 (60.4)n = 96341 (63.5)n = 5370.564
WBC (cells/mm3), median (IQR)7,295 (5,210–9,345)n = 1206,970 (5,380–9,260)n = 7510.9477,750 (6,145–9,775)n = 967,810 (5,900–9,950)n = 5350.961
Leukopenia24 (20)n = 120151 (20)n = 7500.97317 (17.7)n = 9686 (16.1)n = 5350.690
ALC (cells/mm3), median (IQR)1,539 (776–4;3,120)n = 932,444 (1,346–4,329)n = 666<0.0012,295 (1,475–4,556)n = 962,806 (1,616–4,681)n = 4640.186
Lymphopenia51 (54.8)n = 93288 (43.3)n = 6650.03637 (38.5)n = 96200 (37.5)n = 5330.850
ANC (cells/mm3), median (IQR)4,277 (2,280–6,497)n = 943,172 (1,946–5,096)n = 6680.0053,520 (2,110–5,661)n = 963,197 (1,981–5,200)n = 5330.272
Neutropenia8 (8.5)n = 94106 (15.9)n = 6670.06011 (11.5)n = 9685 (16)n = 5330.260
Platelet × 103 (cells/mm3), median (IQR)284 (223–326)n = 120278 (226–337)n = 7530.862269 (236–333)n = 93289 (230–356)n = 5350.649
Thrombocytopenia4 (3.3)n = 12026 (3.5)n = 7531.0002 (2.2)n = 9327 (5.1)n = 5350.290
AST (U/L), median (IQR)30 (22–37)n = 7737 (27–47)n = 6520.00144 (27–49)n = 3439 (30–50)n = 3310.808
Elevated AST12 (15.6)n = 77191 (29.3)n = 6510.0118 (23.5)n = 34115 (34.7)n = 3310.188
ALT (U/L), median (IQR)16 (12–21)n = 2618 (13–25)n = 6520.02319 (16–25)n = 3320 (14–29)n = 3300.829
Elevated ALT6 (7.8)n = 7759 (9.1)n = 6510.7124 (12.1)n = 3350 (15.2)n = 3300.800
TB (mg/dL), median (IQR)0.3 (0.2–0.4)n = 340.3 (0.2–0.4)n = 2190.6610.3 (0.2–0.4)n = 240.3 (0.2–0.5)n = 1740.099
Elevated TB2 (5.9)n = 345 (2.3)n = 2190.2391 (4.2)n = 243 (1.7)n = 1740.406
DB (mg/dL), median (IQR)0.1 (0.1–0.2)n = 320.1 (0.1–0.2)n = 2110.7350.1 (0.1–0.2)n = 230.1 (0.1–0.2)n = 1700.107
Elevated DB2 (5.9)n = 3411 (5.0)n = 2190.6891 (4.2)n = 2411 (6.3)n = 1741.000
Albumin (g/L), median (IQR)45 (42–47)n = 3744 (41–47)n = 2320.48144 (42–46)n = 2443 (40–46)–n = 1880.105
Hypoalbuminemia1 (2.7)n = 3713 (5.6)n = 2320.7000 (0)n = 2413 (6.9)n = 1880.370

Demographics, clinical characteristics, and outcomes of children and adolescents with and without COVID-19 pneumonia and treatment with FPV_

Demographics and clinical characteristicsCOVID-19 non-pneumonia (n = 2,044)COVID-19 pneumonia (n = 955)
No FPV (n = 961)FPV (n = 1,083)PNo FPV (n = 152)FPV (n = 803)P
Age (years)
  <5185 (19.3)578 (53.4)<0.00152 (34.2)459 (57.2)<0.001
  5–18776 (80.7)503 (46.5) 100 (65.8)344 (42.8)
Biological sex (male)n = 961n = 1,081 n = 152n = 803
472 (49.1)588 (54.4)0.01779 (52.0)430 (53.6)0.211
Underlying conditionsn = 863n = 981 n = 148n = 787
109 (12.6)290 (29.6)<0.00125 (16.9)186 (23.6)0.072
  Cardiovascular diseasen = 130n = 335 n = 34n = 192
7 (5.4)30 (9.2)0.1811 (2.9)27 (14.1)0.070
  Gastrointestinal diseasen = 127n = 320 n = 33n = 190
0 (0.0)1 (0.3)1.0000 (0.0)0 (0.0)NA
  Genetic diseasen = 127n = 321 n = 34n = 190
0 (0.0)9 (2.8)0.0661 (3.0)8 (4.2)1.000
  Hematologic malignancyn = 127n = 321 n = 33n = 191
1 (0.8)16 (5.1)0.0501 (3.0)5 (2.6)1.000
  History of preterm birthn = 127n = 320 n = 33n = 193
0 (0.0)11 (3.4)0.0390 (0.0)15 (7.8)0.136
  Neurological diseasen = 128n = 323 n = 34n = 192
4 (3.1)11 (3.4)1.0002 (5.9)17 (8.9)0.746
 Pulmonary diseasen = 139n = 331 n = 35n = 201
44 (31.7)80 (24.2)0.0936 (17.1)56 (27.9)0.184
  Obesityn = 128n = 327 n = 33n = 1930.214
9 (7.0)33 (10.1)0.3111 (3.0)21 (10.9)
  Renal diseasen = 127n = 321 n = 33n = 190
0 (0.0)3 (0.9)0.5620 (0.0)2 (1.1)1.000
  Rheumatological diseasen = 127n = 320 n = 33n = 190
0 (0.0)3 (0.9)0.5620 (0.0)1 (0.5)1.000
  Solid tumorn = 127n = 321 n = 33n = 191
0 (0.0)4 (1.3)0.5810 (0.0)6 (3.1)0.596
  Transplantationn = 127n = 320 n = 33n = 191
0 (0.0)3 (0.9)0.5620 (0.0)2 (1.1)1.000
COVID-19 vaccinationn = 555n = 619 n = 134n = 617
14 (2.5)28 (4.5)0.0651 (0.8)10 (1.6)0.699
Predominant strain during infectionn = 961n = 1,083 n = 152n = 803
  Pre-delta/omicron314 (32.7)62 (5.7)<0.00171 (46.7)134 (16.7)<0.001
  Delta477 (49.6)319 (29.5) 65 (42.8)317 (39.5)
  Omicron170 (17.7)702 (64.8) 16 (10.5)352 (43.8)
SARS-CoV-2 Diagnosis
Rapid antigen test144 (98.0)277 (95.2)0.19612 (92.3)146 (96.1)0.443
n = 147n = 291 n = 13n = 152
Waves
  Pre-delta/omicron1 (100)1 (100)NA2 (100)2 (100)NA
  Delta52 (98.1)40 (95.2)0.5823 (100)32 (100)NA
  Omicron91 (97.9)236 (95.2)0.3667 (88.0)112 (94.9)0.376
Sites
  Non-hospital101 (99.0)49 (98.0)0.5513 (100)14 (100)NA
  Hospital43 (95.6)228 (94.6)1.0009 (90.0)132 (95.7)0.394
  RT-PCR841 (99.8)973 (99.6)0.692149 (100)760 (100)NA
n = 843n = 977 n = 149n = 760
Waves
  Pre-delta/omicron298 (99.3)58 (100)1.00070 (100)130 (100)NA
  Delta447 (100)306 (100)NA64 (100)304 (100)NA
  Omicron96 (100)609 (99.4)1.00015 (100)326 (100)NA
Sites
  Non-hospital477 (99.6)106 (100)1.00068 (100)151 (100)NA
  Hospital364 (100)867 (99.5)0.32681 (100)609 (100)NA
Ct of SARS-CoV-2 RT-PCR at diagnosis, mean ± SD
  N genen = 628n = 773 n = 124n = 629
24.2 ± 6.220.8 ± 5.8<0.00124.3 ± 5.622.4 ± 6.10.001
 ORF genen = 399n = 607 n = 100n = 531
25.2 ± 6.922.0 ± 5.9<0.00124.0 ± 5.622.3 ± 5.90.008
Clinical severityn = 961n = 1,083 n = 152n = 803
  Mild961 (100.0)1,083 (100.0)NA--0.007
  Moderate-- 147 (96.7)708 (88.2)
  Severe-- 4 (2.6)82 (10.2)
  Critical illness-- 1 (0.7)13 (1.6)
Outcomes of treatment
Duration (days) of FPV treatment, median (IQR) n = 1,071 n = 801
-4 (4–5)NA-4 (4–5)NA
Duration (days) between diagnosis and FPV initiation, median (IQR) n = 1,077 n = 802
-1 (0–1)NA-1 (0–2)NA
Duration (days) between symptom onset to FPV initiation, median (IQR) n = 1,046 n = 673
-1 (1–3)NA-2 (1–3)NA
Received antibiotics5 (0.5)44 (4.1)<0.0017 (4.6)89 (11.1)0.015
Received corticosteroids3 (0.3)25 (2.3)<0.0012 (1.3)69 (8.6)0.002
Received oxygenation0 (0.0)8 (0.7)0.0080 (0.0)98 (12.2)<0.001
Isolation
  Home/community296 (30.8)77 (7.1)<0.00121 (13.8)74 (9.2)<0.001
  Field hospital263 (27.4)61 (5.6) 49 (32.3)83 (10.3)
  Hospital402 (41.8)945 (87.3) 82 (54.0)646 (80.5)
Duration of fever (days), median (IQR)n = 558 (5–14)n = 5906 (5–8)0.012n = 2314 (10–14)n = 3827 (5–9)<0.001
Condition at dischargen = 946n = 1,025
  Complete recovery889 (94.0)997 (97.3)<0.001144 (94.7)691 (87.8)0.013
  Partial recovery57 (6.0)28 (2.7) 7 (4.6)96 (12.2)
  Death0 (0.0)0 (0.0) 1 (0.7)0 (0.0)
Length of hospital admission, median (IQR)n = 66310 (7–11)n = 1,0025 (3–8)<0.001n = 13011 (8–13)n = 7208 (5–11)<0.001
  Hospital9 (6–10)n = 4015 (3–8)n = 941<0.00112 (8–13)n = 818 (4–10)n = 638<0.001
  Field hospital10 (8–12)n = 26211 (9–12)n = 610.07410 (8–12)n = 4911 (9–13)n = 820.074

Demographic and clinical characteristics of COVID-19 participants with and without pneumonia and partial or complete clinical recovery at discharge_

Potential factorsCOVID-19 non-pneumoniaCOVID-19 pneumonia
Partial clinical recovery (n = 85)Complete clinical recovery (n = 1886)PPartial clinical recovery (n = 104Complete clinical recovery (n = 835)P
Age (years)
 <517 (20.0)700 (37.1)0.00157 (54.8)443 (52.7)0.735
 5–1868 (80.0)1,184 (62.8) 47 (45.2)392 (47.0)
Biological sex (male)37 (43.5)n = 85983 (52.2)n = 18840.11954 (51.9)439 (52.6)0.900
Underlying disease or condition14 (16.7)n = 84367 (21.6)n = 16960.27833 (32.4)n = 102174 (21.3)n = 8190.011
Cardiovascular disease1 (6.7)n = 1535 (8.4)n = 4171.0005 (16.1)n = 3122 (11.5)n = 1910.466
Gastrointestinal disease0 (0.0)0 (0.0)NA2 (2.0)n = 980 (0.0)n = 8040.012
Genetic disease0 (0.0)n = 156 (1.4)n = 4111.0001 (3.2)n = 318 (4.2)n = 1891.000
Hematologic malignancy0 (0.0)n = 1517 (4.1)n = 4111.0000 (0.0)n = 316 (3.2)n = 1890.598
History of preterm birth1 (6.7)n = 1510 (2.4)n = 4100.3305 (16.1)n = 3110 (5.2)n = 1910.025
Neurological disease0 (0.0)n = 1512 (2.9)n = 4141.0005 (14.7)n = 3413 (6.9)n = 1880.164
Obesity2 (13.3)n = 1539 (9.4)n = 4170.6443 (9.7)n = 3119 (10.0)n = 1911.000
Pulmonary disease6 (40.0)n = 15117 (27.0)n = 4330.25514 (42.4)n = 3348 (24.1)n = 1990.028
Renal disease0 (0.0)n = 153 (0.7)n = 4111.0000 (0.0)n = 312 (1.1)n = 1881.000
Rheumatological disease0 (0.0)n = 153 (0.7)n = 4101.0000 (0.0)n = 311 (0.5)n = 1881.000
Solid tumor0 (0.0)n = 154 (1.0)n = 4111.0001 (3.2)n = 315 (2.7)n = 1891.000
Transplantation0 (0.0)n = 153 (0.7)n = 4101.0000 (0.0)n = 312 (1.1)n = 1891.000
COVID-19 vaccination4 (8.3)n = 4836 (3.3)n = 360.0801 (1.4)n = 717(1.2)n = 5960.596
Predominant strain during infection <0.001 <0.001
 Pre-delta/pre-omicron25 (29.4)347 (18.4) 8 (7.7)195 (23.4)
 Delta42 (49.4)740 (39.2) 55 (52.9)327 (39.2)
 Omicron18 (21.2)799 (42.4) 41 (39.4)313 (37.5)
Ct of SARS-CoV-2 RT-PCR, median (IQR)
 N gene20.2(17–24)n = 6021.3(17.6–26.5)n = 13060.07821.5(18.3–25.2)n = 8721.4(18.3–26.8)n = 6560.769
 ORF gene22.2(16.7–25)n = 3022(18.4–27.9)n = 9450.40020.8(17.5–25)n = 6821.1(18.5–25.9)n = 5500.458
Clinical severity 0.001
 Mild85 (100)1,883 (100)NA--
 Moderate-- 89 (85.6)751 (89.9)
 Severe-- 9 (8.7)76 (9.1)
 Critical-- 6 (5.8)8 (1.0)
Laboratory results at COVID-19 diagnosis
 Anemia11 (73.3)n = 15253 (69.1)n = 3661.00012 (63.2)n = 1999 (64.7)n = 1530.894
 Leukopenia1 (6.7)n = 1559 (16.2)n = 3660.4833 (15.8)n = 1929 (18.8)n = 1541.000
 Neutropenia1 (6.7)n = 1537 (15.2)n = 2430.7053 (15.8)n = 1920 (13.0)n = 1540.722
 Lymphopenia2 (13.3)n = 1564 (26.5)n = 2420.3673 (15.8)n = 1946 (28.9)n = 1540.282
 Thrombocytopenia0 (0.0)n = 158 (2.1)n = 3711.0003 (15.8)n = 192 (1.3)n = 1510.010
 Elevated AST1 (16.7)n = 646 (18.7)n = 2461.0002 (28.6)n = 713 (25.5)n = 511.000
 Elevated ALT0 (0.0)n = 622 (8.9)n = 2461.0002 (28.6)n = 79 (18.0)n = 500.610
 Elevated TB0 (0.0)n = 43 (1.7)n = 1721.0001 (25.0)n = 40 (0.0)n = 420.087
 Elevated DB0 (0.0)n = 47 (4.1)n = 1721.0002 (50.0)n = 40 (0.0)n = 420.006
 Hypoalbuminemia0 (0.0)n = 42 (1.2)n = 1721.0001 (25.0)n = 43 (7.3)n = 410.320
 CRP (mg/L), median (IQR)3.4(2.9–7.7)n = 51.6(0.6–4.2)n = 1170.0805.2(3.8–9.5)n = 73.0(1.8–13.0)n = 360.377
Treatment
FPV28 (32.9)997 (52.9)<0.00196 (92.3)691 (82.8)0.013
Steroids0 (0.0)27 (1.4)0.6288 (7.7)63 (7.5)0.957
Antibiotics2 (2.4)47 (2.5)1.00015 (14.4)80 (9.6)0.123
Antifungal agents0 (0.0)1 (0.1)1.0000 (0.0)0 (0.0)NA
Oxygenation0 (0.0)7 (0.4)1.00014 (13.5)84 (10.1)0.285
ICU admission0 (0.0)4 (0.2)1.00014 (13.5)35 (4.2)<0.001
Duration of ICU stay, median (IQR)0 (0.0)5 (3–8)n = 3NA3 (2.5–8)n = 87.5 (4.5–11)n = 280.073
Duration of FPV administration, median (IQR)4 (4–5)n = 28 0.8934 (4–5)n = 964 (4–5)n = 6890.069
Time from diagnosis until FPV administration, median (IQR)1 (1–2)n = 281 (0–1)n = 9930.0751 (0–2)n = 961 (0–2)n = 6900.834
Time from COVID-19 symptom onset until FPV administration, median (IQR)2 (1–3)n = 271 (1–3)n = 9670.4071 (1–3)n = 692 (1–3.5)n = 5880.354

Potential factors for predicting clinical recovery at discharge of patients with and without COVID-19 pneumonia

FactorsCOVID-19 non-pneumoniaCOVID-19 pneumonia
OR (95% CI)PaOR (95% CI)POR (95% CI)PaOR (95% CI)P
Age (years)
  <52.4 (1.4, 4.1)0.0021.9 (1.1, 3.3)0.030
  5–18Reference Reference
Underlying disease
  History of preterm birth 0.3 (0.1, 0.9)0.0330.2 (0.1, 0.7)0.011
  Pulmonary disease 0.4 (0.2, 0.9)0.0310.4 (0.2, 0.9)0.028
Predominant strain during infection
  Pre-delta/omicronReference Reference
  Delta1.3 (0.8, 2.1)0.360 0.2 (0.1, 0.5)<0.001
  Omicron3.2 (1.7, 5.9)<0.001 0.3 (0.1, 0.7)0.003
Treatment
FPV2.3 (1.4, 3.6)<0.0011.9 (1.2, 3.1)0.0100.4 (0.2, 0.8)0.016
ICU admission 0.2 (0.1, 0.5)<0.0010.1 (0.1, 0.4)0.001

Clinical manifestations of COVID-19 patients with and without pneumonia and favipiravir treatment at the time of diagnosis

Clinical manifestationsCOVID-19 non-pneumoniaCOVID-19 pneumonia
No FPVn = 961FPVn = 1083PNo FPVn = 152FPV n= 803P
Fever497 (52.0)n = 956912 (84.5)n = 1079<0.00153 (34.9)n = 152614 (76.7)n = 801<0.001
Chills4 (0.4)n = 9568 (0.7)n = 10790.3971 (0.7)n = 1522 (0.3)n = 8010.804
Conjunctivitis3 (2.1)n = 1402 (1.4)n = 1470.6780 (0.0)n = 202 (0.9)n = 2331.000
Nasal discharge450 (48.7)n = 925446 (41.9)n = 10650.00269 (59.0)n = 117357 (46.7)n = 7650.013
Dyspnea13 (1.4)n = 91920 (1.9)n = 10600.4135 (4.4)n = 11576 (10.0)n = 7630.053
Cough654 (70.3)n = 930661 (61.9)n = 1068<0.00190 (77.6)n = 116542 (70.6)n = 7680.119
Abdominal pain11 (1.2)n = 92021 (2.0)n = 10600.1675 (4.4)n = 1155 (0.7)n =7630.005
Diarrhea78 (8.5)n = 921142 (13.4)n = 1062<0.00113 (11.3)n = 115102 (13.3)n = 7650.547
Nausea/vomiting38 (4.1)n = 920207 (19.5)n = 1062<0.0019 (7.8)n = 115120 (15.7)n = 7630.026
Rash5 (0.5)n = 9197 (0.7)n = 10600.7400 (0)n = 1153 (0.4)n = 7631.000
Febrile seizure0 (0.0)n = 91918 (1.7)n = 1060<0.0012 (1.7)n = 11538 (5.0)n = 7630.120
DOI: https://doi.org/10.2478/abm-2026-0011 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
Language: English
Page range: 96 - 113
Published on: Apr 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year

© 2026 Sujittra Chaisavaneeyakorn, Nopporn Apiwattanakul, Chonnamet Techasaensiri, Nattakarn Tantawarak, Bandit Thinkhamrop, Supattra Rungmaitree, Siriporn Phongjitsiri, Tavitiya Sudjaritruk, Suvaporn Anugulruengkitt, Pope Kosalaraksa, Thirapa Nivesvivat, Puttichart Khantee, Pornumpa Bunjoungmanee, Panit Takkinsatian, Thiraporn Kanjanaphan, Rudiwilai Samakoses, Tim R. Cressey, Henry Pertinez, Andrew Owen, Kulkanya Chokephaibulkit, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.