The effect of Favipiravir on liver enzyme among patients with mild to moderate COVID-19 infection: A prospective cohort study
Main Article Content
Keywords
ALP, ALT, AST, bilirubin, COVID-19, favipiravir, liver function tests
Abstract
Teratogenicity and hyperuricemia are considered as the major adverse effects of favipiravir, but less is known about other possible side effects which includes drug-induced liver damage and renal injury. In the current research, assessment of favipiravir-induced liver injury was performed by evaluating liver enzymes among patients with mild to moderate COVID-19 infection.A prospective cohort study was conducted on 66 patients diagnosed with mild to moderate COVID-19 infection who were treated with favipiravir for 5 days. During this period, a baseline assessment of liver enzymes (aspartate aminotransferase – AST, ala-nine transaminase – ALT and alkaline phosphatase – ALP) in addition to bilirubin before initiation of ther-apy and after 1 day of completion of therapy were carried out. The comparison of all measured parameters among all patients before and after receiving the treatment showed that non-significant differences were obtained in their levels. It was noticed that COVID-19 patients demonstrated high AST levels in which only 16 patients out of the all-subjected cases (66 patients) had AST levels of less than 45 U/L whereas the major-ity of patients showed normal ALT, ALP, and bilirubin levels. It was concluded that 5 days administration of favipiravir in mild to moderate COVID-19 patients who had no previous liver diseases did not affect the liver enzymes significantly and only transient elevations were occurred.
References
2.Chen N, Zhou M, Dong X, Qu J, et al.Epidemiological and clinical characteristics of99 cases of 2019 novel coronavirus pneumoniain Wuhan, China: a descriptive study.Lancet(London, England).2020;395(10223):507–13.https://doi.org/10.1016/S0140-6736(20)30211-7
3.Liu J, Shu YL, Zhou XN. Transmission patternsand control of COVID-19 epidemic. Indian JPlantPhysiol. 2020;9:112.
4.Rothe C, Schunk M, Sothmann P, Bretzel G,etal. Transmission of 2019-nCoV infection froman asymptomatic contact in Germany.N Engl JMed.2020;382(10):970–1. ht t ps://doi.org /10.1056/N EJ Mc20 01468
5.Singhal T. A review of coronavirus disease-2019(COVID -19).Indian J Pediatr.2020;87(4):281– 6.https://doi.org/10.1007/s12098-020-03263-6
6.Pei G, Zhang Z, Peng J, Liu L, et al. Renal involve-ment and early prognosis in patients with COVID-19 pneumonia.JASN.2020;31(6):1157–65. htt ps://doi.org/10.1681/ASN.2020030276
7.Cai Q, Huang D, Yu H, Zhu Z, et al. COVID-19: Abnormal liver function tests.J Hepatol.2020;73(3):566–74. ht t ps://doi.org /10.1016/j.jhep.2020.04.006
8.Mohammed AA, Mustafa MN, Abdulsattar SA,Al-zaid, AS. COVID 19: Evaluate of liver andrenal function tests in Iraqi patients. Medico-legalupdate. 2021;21(1):7–10. https://doi.org/10.37506/mlu.v21i1.2268
9.Ozma MA, Maroufi P, Khodadadi E, Köse Ş, et al.Clinical manifestation, diagnosis, prevention andcontrol of SARS-CoV-2 (COVID-19) during theoutbreak period. Infez Med. 2020;28(2):153–65.PM I D: 32275257.
10.Humar A, McGilvray I, Phillips MJ, Levy GA.Severe acute respiratory syndrome and the liver.Hepatology. 2004;39:291– 4. ht t ps://doi.org /10.1002/hep.20069
11.Chan HL, Leung WK, To KF, Chan PK.Retrospective analysis of liver function derange-ment in severe acute respiratory syndrome. Am JMed. 2004;116(8):566–7. ht t ps://doi.org /10.1016/j.amjmed.2003.11.024
12.Du YX, Chen XP. Favipiravir: Pharmacokineticsand concerns about clinical trials for 2019-nCoVinfection. Clin Pharmacol Ther. 2020;108(2):242–7. ht t ps://doi.org /10.1002/cpt.1844
13.Nagata T, Lefor AK, Hasegawa M, Ishii M.Favipiravir: Anew medication for the Ebola virusdisease pandemic. Disaster Med Public Health Prep.2015;9(1):79 –81. ht t ps://doi.org /10.1017/d mp.2014.151
14.Nguyen TH, Guedj J, Anglaret X, Laouénan C.Favipiravir pharmacokinetics in ebola-infectedpatients of the JIKI trial reveals concentra-tions lower than targeted. PLoS Negl Trop Dis.2017;11(2):e0005389. https://doi.org/10.1371/jour-nal.pntd.0005389
15.Furuta Y, Komeno T, Nakamura T. Favipiravir(T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci. 2017;93(7):449 – 63. https://doi.org/10.2183/pjab.93.027
16.Yamazaki S, Suzuki T, Sayama M, NakadaTA.Suspected cholestatic liver injury inducedby favipiravir in a patient with COVID-19. JInfect Chemother. 2021;27(2):390–2. htt ps://doi.org/10.1016/j.jiac.2020.12.021
17.Bertolini A, van de Peppel IP, Bodewes FAJA,Moshage H. abnormal liver function tests inpatients with COVID-19: Relevance and potentialpathogenesis. Hepatology. 2020;72(5):1864–72.ht t ps://doi.org /10.1002/ hep.31480
18.Kumar A, Kumar P, Dungdung A, Kumar GuptaA. Pattern of liver function and clinical profile inCOVID-19: A cross-sectional study of 91 patients.Diabetes Metab Syndr. 2020;14(6):1951–4. htt ps://doi.org/10.1016/j.dsx.2020.10.001
19.Çetin Kargin N. The effect of smoking on COVID-19-linked biomarkers in hospitalized patients withCOVID-19. J Clin Lab Anal. 2021;35(10):e23983.https://doi.org/10.1002/jcla.23983
20.Hassanipour S, Arab-Zozani M, Amani B,Heidarzad F. The efficacy and safety of Favipiravirin treatment of COVID-19: A systematic reviewand meta-analysis of clinical trials. Sci Rep.2021;11(1):11022. ht t ps://doi.org /10.1038/s41598-021-90551- 6
21.Udwadia ZF, Singh P, Barkate H, Patil S. Efficacyand safety of favipiravir, an oral RNA-dependent RNA polymerase inhibitor, in mild-to-moderate COVID-19: A randomized, comparative, open-label, multicenter, phase 3 clinical trial. Int J Infect Dis. 2021;103:62–71. ht t ps://doi.org /10.1016/j.ijid.2020.11.142
22.Khamis F, Al Naabi H, Al Lawati A, AmbusaidiZ.Randomized controlled open label trial on the useof favipiravir combined with inhaled interferonbeta-1b in hospitalized patients with moderate tosevere COVID-19 pneumonia. Int J Infect Dis.2021;102:538–43. ht t ps://doi.org /10.1016/j.ijid.2020.11.0 0 8
23.Erdem HA, Korkma PE, Çağlayan D, IşıkgözTaşbakan M. Treatment of SARS-CoV-2 pneu-monia with favipiravir: Early results from theEge University cohort, Turkey. Turk J Med Sci.2021;51(3):912 –20. https://doi.org/10.3906/sag-2008-33
24.Kumar P, Kulkarni A, Sharma M, Rao PN.Favipiravir-induced liver injury in patientswith coronavirus disease 2019. J Clin TranslHepatol. 2021;9(2):276–8. https://doi.org/10.14218/JCTH.2021.00011
25.Hwaiz R, Merza M, Hamad B, HamaSalih S.Evaluation of hepatic enzymes activities inCOVID-19 patients. Int Immunopharmacol.2021;97:107701. https://doi.org/10.1016/j.intimp.2021.107701
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