COVID-19 and the liver: What do we know so far?

Table 1 Impact of drugs currently used for the management of coronavirus disease 2019 on the liver

Drug	Mechanism of action	Impact on CLD management
Remdesivir	Viral RNA-dependent RNA polymerase inhibitor	Liver toxicity possible; No liver relevant drug-drug interactions
Lopinavir/ritonavir	Protease inhibitors	mTOR inhibitors (sirolimus, everolimus) should not be co-administered; Close monitoring of drug level is required for calcineurin inhibitors (cyclosporine, tacrolimus); The risk of lopinavir-associated hepatotoxicity in patients with very advanced liver disease is low; Patients with decompensated cirrhosis should not be treated
Tocilizumab	Humanized monoclonal antibody targeting interleukin-6 receptor	Patients with decompensated cirrhosis should not be treatedConsider risk of HBV reactivation
Methylprednisolone (steroids)	Bind nuclear receptors todampen proinflammatory cytokines	The risk of other infections (e.g., spontaneous bacterial peritonitis) and viral shedding may increase in patents with decompensated liver cirrhosis; Consider antimicrobial prophylaxis; Consider risk of HBV reactivation
Favipiravir	Guanine analogue, RNA-dependent RNA polymerase	Elevation of ALT and AST possible; No data in cirrhosis available

ACE-2: Angiotensin-converting enzyme; CLD: Chronic liver disease; G6PD: Glucose-6-phosphate dehydrogenase; HBV: Hepatitis B virus; mTOR: Mammalian target of rapamycin; SBP: Spontaneous bacterial peritonitis.