Hepatotoxicity in Patients Using Favipiravir for COVID-19: A Retrospective Study

Background: Antimalarial drugs (hydroxychloroquine sulfate), antiretroviral drugs (lopinavir/ritonavir), and antivirals (oseltamivir, remdesivir and favipiravir) are medications used for the treatment of Coronavirus disease-2019 (COVID-19). A detailed safety analysis of favipiravir, which is used extensively in the treatment of COVID-19 in our country under pandemic conditions, is important. Investigation of the hepatotoxicity risk of favipiravir in COVID-19 patients. Our study was designed retrospectively. Materials and Methods: Demographic characteristics, comorbid diseases and liver function test (LFT) values of the patients were retrospectively scanned and recorded. The patients were divided into two groups as died and recovered according to their results. The changes in the mean values of the LFT results and patients with different results than the reference value was evaluated according to the treatment time. Results: Mean age of the 175 patients included in the study was 60.9±16.4 years and 122 of them were male. In the total patient population, significant (p<0.05) differences were found between the mean values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin on day 1 and on the days 3 and 5. As for gamma glutamyl transferase (GGT), the difference between all three consecutive measurements was significant (p<0.05). The change in the number of patients with abnormal, international normalized ratio (INR), alkaline phosphatase (ALP), GGT, AST, ALT, and albumin values based on treatment days was statistically significant (p<0.05). Analysis of this difference according to groups showed a significant difference for GGT, AST, and ALT in the survivors and for total bilirubin, ALP, INR, and albumin in the deceased (p<0.05). Conclusion: It was observed that GGT, AST and ALT increased after the drug loading dose. This condition was evaluated as drug-related hepatotoxicity. However, no serious height was found in any patient to require discontinuation of favipiravir. Therefore, close monitoring for hepatotoxicity is recommended in patients treated with favipiravir, especially after the loading dose.