The effect of favipiravir on QTc interval in patients hospitalized with coronavirus disease 2019

Abstract

Background The effect of favipiravir on the QTc interval during the treatment of Coronavirus Disease 2019 (COVID-19) patients is unclear. Thus, the current study objective was to evaluate any change in the QTc interval in patients who were hospitalized due to COVID-19 receiving favipiravir treatment. Method Patients hospitalized with COVID-19 were assessed in this single-center retrospective study. 189 patients, whose diagnosis was confirmed using real-time PCR, were included in the study. The patients were divided into three groups: those using hydroxychloroquine (Group 1, n = 66), hydroxychloroquine plus favipiravir (Group 2, n = 66), and favipiravir only (Group 3, n = 57). The QTc interval was measured before treatment (QTc-B) and 48 h after (i.e., the median) starting treatment (QTc-AT). Results The median age was 53 (39–66 IQR) and 97 (51%) of patients were female. The median QTc(Bazett)-change was 7 ms ( p = 0.028) and 12 ms ( p < 0.001) and in Group 1 and 2, respectively. In Group 3, the median QTc(Bazett)-change was observed as −3 ms and was not statistically significant ( p = 0.247). In multivariable analysis, while there was a significant relationship between QTc-AT(Bazett) and hydroxychloroquine (β coefficient = 2687, 95%CI 2599–16,976, p = 0,008), there was no significant relationship with favipiravir (β coefficient = 0,180, 95% CI -6435-7724, p = 0,858). Similarly, there was a significant relationship between the QTc-AT interval calculated using the Fredericia formula and hydroxychloroquine (β coefficient = 2120, 95% CI 0,514–14,398, p = 0,035), but not with favipiravir (β coefficient = 0,111, 95% CI -6450- 7221, p = 0,911). Conclusion In the ECG recordings received in the following days after the treatment was started in COVID-19 patients, there was a significant prolongation in the QTc interval with hydroxychloroquine, but there was no significant change with favipiravir.

Effect of COVID‐19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

“…In a case report, QTc prolongation was observed on the 9th day of treatment in a patient who was using favipiravir for Ebola virus infection 21 . However, small study by Cap et al in COVID‐19 patients showed no significant increase in QTc interval 22 . Together, available data indicate that favipiravir is better tolerated in terms of cardiac arrhythmia in COVID‐19 patients.…”

“…21 However, small study by Cap et al in COVID-19 patients showed no significant increase in QTc interval. 22 Together, available data indicate that favipiravir is better tolerated in terms of cardiac arrhythmia in COVID-19 patients.…”

Effectiveness and Safety of Favipiravir Compared to Hydroxychloroquine for Management of Covid-19: A Retrospective Study

“… 26 , 27 Also, Çap et al reported that in the ECG recordings received in the following days after the treatment was started in COVID-19 patients, there was a significant prolongation in the QT interval with HCQ, but there was no significant change with FPV. 28 Moreover, the effect of FPV on the QT interval in healthy adults was evaluated in a small-scale study (56 participants) in Japan. Patients were randomly assigned to receive 1200 mg FPV, 2400 mg FPV, moxifloxacin, or a placebo.…”

Correlation of inflammatory cytokines on corrected QT interval in rifampicin-resistant tuberculosis patients

“…Fridericia formula is a formula recommended by the U.S. Food and Drug Administration (FDA) for clinical trials on drug safety. Fridericia formula calculation is QTc = QT/[R - R]1/3 [ 19 , 20 ].…”