Remdesivir Induced Liver Injury and Severe COVID-19 Infection

Chanchal Kumar Ghosh,S M Ali Hasan,Suman Dey

doi:10.11648/j.ajim.20200806.18

Abstract

Background and Aims: Remdesivir is identified as an effective therapeutic option in COVID-19, but its’ hepatic safety has not been well studied. So, we aimed to identify the pattern and severity of hepatotoxicity in remdesivir treated COVID-19 patients. Methods: This cross-sectional study was carried out at a dedicated COVID-19 unit of a university hospital in Dhaka, Bangladesh among severe COVID-19 cases. Alterations of liver functions were compared between the remdesivir and the non-remdesivir treated patients. Results: Out of 50 severe COVID-19 cases 25 had received remdesivir and 25 had received other supportive care without remdesivir. Median serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were significantly higher in the remdesivir treated arm (p-value for AST <0.0001 and ALT <0.001). Grade-2 elevation of AST and ALT and grade-3 elevation of AST levels were significantly higher among the remdesivir treated group. No patients had significant bilirubin elevation (≥2.5 mg/dl) and only 1 patient had INR >1.5 in the remdesivir treated arm. Conclusion: Many of the patients with severe COVID-19 had mild to moderate aminotransferases elevation. If the elevation of liver enzymes occurs after the initiation of remdesivir, adverse drug reactions need to be considered and drug discontinuation may require if severe elevation occurs.

Highlights

At the end of 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan city, China results in a respiratory illness designated as coronavirus disease 2019 (Covid-19) [1]
Remdesivir, a nucleoside analog, an inhibitor of the viral RNA-dependent, RNA polymerase [5, 6] has been identified as a promising therapeutic option for Covid-19 because it inhibits SARS-CoV-2 in vitro [7]
We aimed to conduct a study to find out the patterns and severity of liver injury in COVID-19 patients treated with remdesivir

Summary

Introduction

At the end of 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan city, China results in a respiratory illness designated as coronavirus disease 2019 (Covid-19) [1]. It was initially viewed as primarily a respiratory disease, but is considered as a complex multisystem disease [2]. We aimed to conduct a study to find out the patterns and severity of liver injury in COVID-19 patients treated with remdesivir. Remdesivir is identified as an effective therapeutic option in COVID-19, but its’ hepatic safety has not been well studied. If the elevation of liver enzymes occurs after the initiation of remdesivir, adverse drug reactions need to be considered and drug discontinuation may require if severe elevation occurs

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