Favipiravir use in children with COVID-19 and acute kidney injury: is it safe?

Abstract

Background The rising number of infections due to Severe Acute Respiratory Syndrome Coronavirus-2 (popularly known as COVID-19) has brought to the fore new antiviral drugs as possible treatments, including favipiravir. However, there is currently no data regarding the safety of this drug in patients with kidney impairment. The aim of this paper, therefore, is to share our experience of the use of favipiravir in pediatric patients affected by COVID-19 with any degree of kidney impairment. Methods The study enrolled pediatric patients aged under 18 years and confirmed as suffering from COVID-19 and multisystem inflammatory syndrome in children (MIS-C) with any degree of kidney injury, who were treated with favipiravir at the time of admission. Results Out of a total of 11 patients, 7 were diagnosed with MIS-C and 4 with severe COVID-19. The median age of the cases was 15.45 (9–17.8) years and the male/female ratio was 7/4. At the time of admission, the median serum creatinine level was 1.1 mg/dl. Nine patients were treated with favipiravir for 5 days, and 2 patients for 5 days followed by remdesivir for 5–10 days despite kidney injury at the time of admission. Seven patients underwent plasma exchange for MIS-C while 2 severely affected cases underwent continuous kidney replacement therapy (CKRT) as well. One severe COVID-19 patient received plasma exchange as well as CKRT. Serum creatinine values returned to normal in mean 3.07 days. Conclusions Favipiravir seems a suitable therapeutic option in patients affected by COVID-19 with kidney injury without a need for dose adjustment. Supplementary Information The online version contains supplementary material available at 10.1007/s00467-021-05111-x.

Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review

“…Favipiravir was used with no dose adjustment and no measurement of plasma levels by Ozsurekci and colleagues in two out of 11 critically ill children diagnosed with the multisystem inflammatory syndrome in children (MIS-C) after Covid-19 infection, on CKRT, with eGFR <30 ml/min/1.73 m 2 ( 35 ). Doses followed weight as per the recommendations for Ebola ( Table 9 ), without any dose adjustment for kidney dysfunction.…”

Investigation of developmental toxicity of favipiravir on fetal bone and embryonic development

“…There are also first‐time or re‐emerging viral infections for which effective drug or vaccine treatments are not available (Furuta et al, 2017). Nowadays, the most obvious example of this situation is COVID‐19 and favipiravir is used effectively in its treatment by some countries (Furuta et al, 2017; Ozsurekci et al, 2021).…”

“…The main elimination route of the drug is via the kidneys, and inactive metabolites produced by aldehyde oxidase and xanthine oxidase are excreted in the urine. It has been reported that its side effects have a safer profile than most antiviral agents (Ozsurekci et al, 2021). However, its use is contraindicated in patients with severe hepatic and renal impairment, hypersensitivity, and hyperuricemia.…”

“…Favipiravir is one of the current drugs used for the treatment of COVID-19 in Turkey. Although it is reported to have a good safety profile in general, it is also recommended by the Turkish Ministry of Health for severe pediatric COVID-19 cases (Ozsurekci et al, 2021). However, there is insufficient evidence-based retrospective data on its use in pregnancy.…”

A Single-Centered Cohort Study on Favipiravir Safety and Efficacy in Pediatric Patients with COVID-19

“…Additionally, some warnings have been issued, and adverse reactions, including bone marrow suppression, hepatotoxicity, and hypersensitivity reaction, were reported (12). and efficacy of favipiravir in the pediatric population (13,14) and no specific reported dosing recommendation for the pediatric population, the used dosage was derived from the limited data for this drug in the treatment of Ebola in children.…”