What factors predispose patients to hyperuricaemia following favipiravir treatment?

An already elevated serum uric acid level at baseline and achievement of high steady-state serum favipiravir concentrations during therapy contribute to an increased risk of developing treatment-induced hyperuricaemia, according to a study.

To identify the risk factors associated with favipiravir-associated hyperuricaemia, researchers used specimens from 66 COVID-19 patients who were treated with the drug for 10 days in a previous clinical trial. They measured serum favipiravir concentrations using liquid chromatography–mass spectrometry analysis.

The median age of the cohort was 48.5 years, and the median body mass index was 22.8 kg/m². Most of the patients (60.6 percent) were men, and the median baseline serum uric acid level was 4.6 mg/dL.

A total of 40 patients developed subsequent hyperuricaemia. This group had significantly lower aspartate aminotransferase levels (22.0 vs 28.5 U/litre), higher baseline serum uric acid levels (4.9 vs 3.6 mg/dL), and higher serum favipiravir concentrations (6th day: 60.85 vs 35.22 μg/mL; 11th day: 29.48 vs 9.61 μg/mL) than the group of patients without hyperuricaemia.

The steady-state serum favipiravir concentrations showed a significant correlation with serum uric acid levels. High baseline serum uric acid levels and steady-state serum favipiravir concentrations during therapy emerged as significant risk factors for the development of treatment-induced hyperuricaemia.

The cutoff values for predicting hyperuricaemia were 3.7 mg/dL for baseline serum uric acid level and 46.14 μg/mL for steady-state serum favipiravir concentration during treatment.