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

Pediatr Nephrol. 2021 Nov;36(11):3771-3776. doi: 10.1007/s00467-021-05111-x. Epub 2021 May 22.

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.

Keywords: COVID-19; Favipiravir; Pediatrics; Remdesivir; SARS-CoV-2.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / immunology
  • Acute Kidney Injury / physiopathology*
  • Acute Kidney Injury / virology
  • Adenosine Monophosphate / administration & dosage
  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / pharmacokinetics
  • Adolescent
  • Alanine / administration & dosage
  • Alanine / analogs & derivatives
  • Alanine / pharmacokinetics
  • Amides / administration & dosage*
  • Amides / pharmacokinetics
  • COVID-19 / complications*
  • COVID-19 / immunology
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Child
  • Creatinine / blood
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Pyrazines / administration & dosage*
  • Pyrazines / pharmacokinetics
  • Renal Elimination*
  • SARS-CoV-2 / isolation & purification
  • Systemic Inflammatory Response Syndrome / complications
  • Systemic Inflammatory Response Syndrome / drug therapy*
  • Systemic Inflammatory Response Syndrome / immunology
  • Systemic Inflammatory Response Syndrome / virology
  • Treatment Outcome

Substances

  • Amides
  • Pyrazines
  • remdesivir
  • Adenosine Monophosphate
  • Creatinine
  • favipiravir
  • Alanine

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related