First experience of using favipiravir in the first healthcare worker patient with moderate case of Coronavirus Disease 2019 (COVID-19) at Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia: a case report
Abstract
Background: During the early period of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, there was no approved and definitive drug available for the treatment of COVID-19. Favipiravir, chloroquine, hydroxychloroquine was used for re-purposing drugs while their efficacy and safety remained a major concern for healthcare workers. Clinical trial to assess efficacy and safety were ongoing.
Case presentation: We present here the case of a 38-year-old woman, the first case of a healthcare worker diagnosed with COVID-19 who had moderate type, including first experience treatment with favipiravir in Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia. We present the clinical characteristics, chest X-ray, clinical laboratory profiles, the treatment process with favipiravir and hydroxychloroquine as well as the clinical outcome of moderate type COVID-19 patient.
Conclusion: This case highlights that considering the use of emergency intervention outside of clinical trial in the COVID-19 population, the informed patient consent has been given and the use of emergency intervention was monitored.
Keywords: COVID-19, favipiravir, medical worker, case report, Jakarta
Abstrak
Latar belakang: Periode awal pandemi Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), belum terdapat obat yang disetujui dan pasti tersedia untuk pengobatan COVID-19. Favipiravir, chloroquine, hydroxychloroquine digunakan sebagai obat dengan indikasi baru yang sementara efektifitas dan keamanannya menjadi perhatian para petugas medis.
Penyajian kasus: Disini kami melaporkan kasus wanita umur 38 tahun, merupakan kasus pertama seorang tenaga kesehatan Rumah Sakit terdiagnosis Coronavirus Disease 2019 (COVID-19) dengan penggunaan terapi favipiravir untuk pertama kalinya di Rumah Sakit Pusat Infeksi Sulianti Saroso, Jakarta, Indonesia. Berikut ini kami gambarkan karakteristik klinis, hasil foto thorak, profil laboratorium dan proses terapi menggunakan favipiravir and hidroxychloroquine serta hasil akhir pada kasus COVID-19 derajat sedang.
Kesimpulan: Kasus ini menggaribawahi bahwa pertimbangan penggunaan kegawatdaruratan obat antivirus diluar uji klinis pada populasi pasien COVID-19, pasien telah memberikan persetujuan dan penggunaan obat-obat tersebut dimonitor.
Kata kunci: Covid-19, favipiravir, tenaga kesehatan, laporan kasus, Jakarta
References
Chang C, Jiangying H, Zhenshun C, Jianyuan W, Song C, Yongxi Z. et al. Favipiravir versus Arbidol for COVID-19: a randomized clinical trial. [cited: May 2, 2020]. Available from https://doi.org/10.1.101/2020.03.17.200337432.
World Health Organization. WHO Indonesia COVID-19 situation report-4. [cited: May 2, 2020]. Available from: https://who-int/Indonesia
Apriadi. More Indonesia doctors, nurses die fighting against COVID-19. [cited: May 20, 2020]. Available from: https://thejakartapost.com.
Rogers C, Tracy Dana, David B, Schelley S, Rongmei F, Annette M. Epidemiology of and risk factors for coronavirus infection in health care workers. ASP Journal. 2020;1632.
James MS, Marguerte LT, James B. Pharmacologic treatment for coronavirusdisease 2019 (COVID-19). JAMA. 2020; E1-E5.
Zarir FU, Pawan S, Hanmant B, Saiprasad P, Shabbir R, Amol P, et al. Efficacy and safety of favipiravir, an oral RNA-dependent RNA polymerase inhibitor, in mild-to-moderate COVID-19: a randomized, comparative, open-label, multicenter, phase3 clinical trial. International Journal of Infectious Diseases. 2020;103:62–71.
World Health Organization. Monitored emergency use of unregistered and experimental interventions (MEURI). [cited: March 20, 2021]. Available from: http://www.who.int/ethics/publications/infectious-disease-outbreaks/en/.
Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical−therapeutic staging proposal. Jhltonline. 2020:405-07.
Eastern Virginia Medical School (EVMS) Medical Group. EVMS Critical Care COVID-19 Management Protocol. [cited: May 6, 2020]. Available from: https://www.evms.edu/covidcare
Minnesota Department of Health. COVID-19 recommendation for health care workers. [cited: March 16, 2021]. Available from: https://www.health.state.mn.us.
Jiˇrí B, Marian ŠVˇera K, Alena H, Jan M,Jana FR, Jiˇrí S. Nosine pranobex significantly decreased the case-fatality rate among PCR positive elderlywith SARS-CoV-2 at three nursing homesin the Czech Republic. Pathogens. 2020;9:1055. doi:10.3390/pathogens912105
Mishima E, Anzai N, Miyazaki M, Abe T. Uric acid elevation by favipiravir, an antiviral drug. Tohoku J Exp Med. 2020;251(2):87-90.
Eroglu E, Toprak C. Overview of favipiravir and remdesivir treatment for COVID-19. Int J Pharm Sci & Res. 2021;12(4):1950-57. doi: 10.13040/IJPSR.0975-8232.12(4).1950-57.
Badan POM RI. Pedoman Monitoring Efek Samping Obat (MESO) bagi tenaga kesehatan. Direktorat Pengawasan Distribusi Produk Terapetik dan PKRT Badan POM RI. Jakarta; 2012. Indonesian.
Kaur RJ, Charan J, Dutta S, Sharma P, Bhardwaj P, Sharma P, et al. Favipiravir use in COVID-19: analysis of suspected adverse drug events reported in the WHO database. Infection and Drug Resistance. 2020;13:4427-38.
Chief Investigators of the Randomised Evaluation Of COVID-19 Therapy. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19 — RECOVERY Trial n.d. [cited: March 20, 2021]. Available from: https://www.recoverytrial.net/news/statement-from-thechief-investigators-of-the-randomised-evaluation-of-covid-19-therapy-recoverytrial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use of hydroxychloroquine-in-hospitalised-patients-with-covid-19.
Niyada N, Sorin L, Thoetchai P. Cardiac safety of off-label COVID-19 drug therapy: a review and proposed monitoring protocol. Eur Heart J Acute Cardiovasc Care. 2020;9:215–21.
Pilkington V, Pepperrell T, Hill A. A review of the safety of favipiravir – a potential treatment in the COVID-19 pandemic?. J Virus Erad. 2020;6(2):45–51.
Ventricular arrhythmia risk due to hidroxychloroquine-azithromycin treatment for COVID-19. [cited: May 3, 2020]. Available from https://www.acc.org/latest-in-cardiology/articles/ 2020/03/27/14/00.
Ghasemiyeh P, Borhani-Haghighi A, Karimzadeh I, et al. Major neurologic adverse drug reactions, potential drug-drug interactions, and pharmacokinetic aspects of drugs used in COVID-19 patients with stroke: a narrative review. Ther Clin Risk Manag. 2020;16:595–605.
Uppsala Monitoring Centre: WHO Programme for International Drug Monitoring. VigiBase. Overview of pharmachovigilance [cited: Nov 28, 2020]. Available from: http://www.lmi.no/download.php?file=/wp-content/uploads/2020/11/UMC-overview-handouts.pdf
Uppsala Monitoring Centre. VigiBase: signaling harm and pointing to safer use. [cited: Nov 28, 2020]. Available from: https://www.who-umc.org/vigibase/vigibase/vigibase-signalling-harm-and-pointing-to-safer-use/.
Kelleni MT, Mahrous A. Drug induced cardiotoxicity: mechanism, prevention and management cardiotoxicity. Wenyong Tan, Intech Open. 2018. DOI: 10.5772/intechopen.79611.
Copyright (c) 2021 Pompini Agustina Sitompul, Nina Mariana, Adria Rusli, Titi Sundari, Rosa Marlina, Faisal Matondang, Haruyuki Dewi Faisal, Mohammad Syahril
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