Distribution of arrhythmic events in COVID-19 patients receiving
favipiravir and hydroxychloroquine
Abstract
Background: Favipiravir, first used for novel influenza strains, is
being used today in coronavirus disease 2019 (COVID-19). While many
studies have been reported in the literature on hydroxychloroquine’s
(HQ) arrhythmogenic adverse effects, data on favipiravir are limited.
The authors purposed to demonstrate that the arrhythmic effects of
favipiravir are not negligible. Methods: The researchers conducted a
retrospective observational study on 194 COVID-19 patients. The study
population was classified into two groups based on the treatment
regimen: favipiravir (n=101) and HQ (n=93). Pre/post-medication
electrocardiograms were evaluated for arrhythmic events. Results: Twenty
of 101 (19.8%) subjects in the favipiravir group and 13 of 93 (13.9%)
subjects in the HQ group had arrhythmogenic events (p=0.42). The most
frequent arrhythmic events in the favipiravir group were sinus
bradycardia (13 of 20, 65%) and third-degree atrioventricular block (4
of 20, 20%). Corrected QT (QTc) prolongation was the most seen
arrhythmogenic adverse effect (9 of 13, 69%) in the HQ group. The
proportion of patients with prolonged QTc were higher in the HQ group
than the favipiravir group (9 vs. 3, p=0.04). However, the difference
between final and baseline QTc did not differ between the HQ and the
favipiravir group (11 [IQR:-9—57] vs. 12 [IQR:-7—103],
p=0.59, respectively). The change between pre and post-treatment heart
rate was more remarkable in the favipiravir group than the HQ group (12
[IQR:-6—70] vs. 5 [IQR:-8—41], p<0.001,
respectively). Conclusions: Favipiravir was significantly associated
with sinus bradycardia requiring drug withdrawal. Clinicians should more
routinely implement arrhythmia monitoring for patients receiving
favipiravir.