การศึกษาผลของฟ้าทะลายโจรอย่างเดียวและใช้ร่วมกับยาฟาวิพิราเวียร์ต่อค่าชีวเคมี ของตับ ในการรักษาผู้ป่วยโรคติดเชื้อไวรัสโคโรนา 2019 (covid-19): การศึกษาย้อนหลัง
Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction and Objective: This study addresses the National Clinical Practice Guideline (CPG) that did not recommend using a combination of favipiravir (FV) and Andrographis paniculata (Burm. f.) Nees (AP, or Fa Thalai Chon in Thai) crude drug (144 mg of andrographolide per day) in the treatment for COVID-19 due to potential serious side effects. The objective is to assess the safety profile of this combination compared to individualdrug use, specifically focusing on liver biochemistry. Additionally, the study aims to identify factors influencingliver function in patients after FV and/or AP usage.Methods: The retrospective design involved retrieving medical records of COVID-19 patients who wereadmitted to Chao Phya Abhaibhubejhr Hospital between January 1 and December 31, 2021, and who receivedeither FV, according to the recommended dose by the CPG for 5–10 days thereafter, or AP, with a dose of 4.8 g ofstandardized powder (equivalent to 144 mg of andrographolide) per day for 5 days, or a combination of both. Themonitoring was undertaken to identify abnormalities in patients’ liver enzymes, namely aspartate transaminase(AST), alanine transaminase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB), by identifying deviationsof 2–3 times beyond the upper limit of normal (ULN).Results: Following the inclusion and exclusion criteria, the records of 564 cases were analyzed. In the assessmentof post-treatment liver enzyme elevation at least 2 times ULN, AP groups (prescribed to younger, healthypatients) showed no elevations in all four enzymes, and no group displayed increased ALP or TB levels. However,0.87% in the FV+AP group had AST levels exceeding 3 times ULN, while 1.06% and 2.17% in the FV and FV+APgroups showed ALT levels over 3 times ULN. One case of drug-induced liver injury (DILI) was observed in bothFV and FV+AP groups. No significant factors increasing abnormal liver enzyme likelihood were identified.Discussion: Some of the findings could support safety concern regarding the use of combined FV and AP.However, it should be noted that patients receiving FV and FV+AP may exhibit greater disease severity, so maythose with higher doses of FV medication, underlying diseases, advanced age, and other concurrent medications.Therefore, it is difficult to conclusively determine whether liver abnormalities are solely attributable to the FV orFV+AP medication. Conclusions and Recommendations: The study indicates that AP at a dose of 144 mg/day showed apromising safety profile for liver function, suggesting its suitability for young and healthy patients. AP shouldalso be considered safe for common cold and influenza, with a dosage 3 times lower than that for COVID-19.However, 1.06% and 2.17% of patients in the FV and FV+AP groups had ALT levels exceeding 3 times, and0.87% in the FV+AP group had AST levels exceeding 3 times ULN, indicating susceptibility to drug-induced liverinjury (DILI). Therefore, careful monitoring of liver function is warranted following the administration of FV andFV+AP, especially in older patients, those with underlying diseases, and those taking concomitant medicationsmetabolized in the liver.
Author: เกษรา, นภัสชญา
Language: English
Subfield: Complementary and alternative medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7217447889