Comparison of Liver Safety of Favipiravir and Hydroxychloroquine in COVID-19 Treatment

Objective: Since the first case from Wuhan, China in December 2019, COVID-19 has spread all over the world and a pandemic was declared by the World Health Organization on January 30, 2020. While there are no specific effective antiviral drugs or vaccines to treat or to prevent COVID-19; favipiravir, hydroxy-chloroquine and their combination are used in the treatment of COVID-19 in Turkey. In this study, it was aimed to evaluate the demographic, clinical and laboratory findings, the treatments given and the effects of treatments on liver tests of the patients followed up with the diagnosis of COVID-19. Methods: This study was retrospectively designed, and included COVID-19 patients who met the "definitive case" criteria in guidelines of Ministry of Health of Turkey between April 3, 2020 and September 28, 2020 in the Department of Infectious Diseases and Clinical Microbiology at Faculty of Medicine, Erciyes University. Age, gender, hospitalization time, comorbidities, malignancies, symptoms, disease severity, antibiotics and other medications used, laboratory and thorax computed tomography findings, and mortality rates were recorded. The patients were divided into two groups as hydroxychloroquine and favipiravir group. Both groups were evaluated in terms of clinical findings, treatment protocols and laboratory findings, particularly liver tests. Results of liver tests were recorded on the 0th, 3rd and 5th days of treatment and 48-72 hours after the end of treatment. Results: A total of 52 patients with COVID-19, 20 in the hydroxychloroquine group and 32 in the favipiravir group, were enrolled in study. Significant differences between two groups were not generally observed in terms of basic characteristics of patients. It was not noticed statistically significant increases in aspartate aminotransferase, alanine aminotransferase (ALT), total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT) and alkaline phosphatase values in the hydroxychloroquine group, but significant increases were found in ALT (p<0.0001), LDH (p=0.01) and GGT (p<0.0001) values in favipiravir group. Conclusions: In addition to the need for other clinical studies to prove the definitive efficacy of favipiravir in the treatment of COVID-19, we think that favipiravir-induced liver damage is an important point that should not be ignored during treatment.