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©The Author(s) 2021.
World J Hepatol. Sep 27, 2021; 13(9): 1143-1153
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1143
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1143
Ref. | Study/site | Patient profile | Medication | DILI | Outcome |
Muhović et al[23] | Case report; Montenegro | Man, 52-yr-old | Chloroquine, lopinavir/ritonavir, methylprednisolone, ceftriaxone and azithromycin. After 6 d: methylprednisolone, ceftriaxone, azithromycin | CIOMS/RUCAM: scored 8 points for a ‘probable’ cause of DILI by TCZ. Hepatocellular form of DILI diagnosed using the EASL guidelines | TCZ had a positive effect on clinical and laboratory parameters, with transaminases values normalizing in 10 d |
Zampino et al[24] | Case series; Naples, Italy | None of the 5 treated patients had history of liver disease, visceral obesity, viral hepatitis, or prior hepatotoxic medication or alcohol intake. Liver ultrasound did not show signs of advanced liver disease. Patient 1 and 2 had history of hypertension and asthma | Before and during RDV treatment, 4 of 5 patients alsoreceived hydroxychloroquine patient 2 and 4 received ceftazidime–avibactam plus daptomycin and patient 3 meropenem and linezolid | Significant increase in AST/ALT | Adverse effect neither progressed to severe liver damage nor induced liver failure. In no cases, RDV was discontinued because of liver injury |
Durante-Mangoni et al[25] | Case series; Naples, Italy | Four patients | All patients had been previously treated with LPV/r or darunavir/cobicistat (DRV/c) and also received hydroxychloroquine | 3 patients experienced ALT and AST increase (5 times to 8 times the upper normal limit) | RDV was prematurely discontinued in patient 1 because of a torsade de pointes requiring cardiac resuscitation and in patient 3 because of death due to multiple organ failure. The study suggests a significant burden of adverse events |
Montastruc et al[26] | Cross-sectional study; United States, Europe | 387 reports with RDV side effects in VigiBase; 130 hepatic adverse effects, 87 from the United States; 43 from Europe; mostly men (81, 62%), mean age of 54.9 yr | In the majority of cases (122, 94%), RDV was the sole suspected drug | Increased hepatic enzymes (114, 88%), involving AST and ALT in 79 cases (61%) and bilirubin in 4 cases (3%). Other cases were reported as hepatic failure or hepatitis | Most cases were serious (94, 72%), resulting in hospitalization or prolongation of hospital stay. The use of RDV was associated with an increased risk of reporting hepatic disorders |
Yamazaki et al[27] | Case reported; Japan | 73-yr-old man. History of hypertension, hyperlipidemia, gastric ulcer, benign prostatic hyperplasia, and alcoholic hepatitis | Favipiravir was the suspected drug. Dosage was 6000 mg on day 1 and 2400 mg/d from day 2 onward, for a total of 14 d. Patient was using previously lopinavir/ritonavir combined with interferon β-1b, vancomycin and antithrombin III. After started fapinavir two more drugs were added Trimethoprim-sulfamethoxazole and micafungin | Transaminases were elevated until day 4: Aspartate aminotransferase (AST) from 70 U/L (day 0) to 112 U/L (day 4) and alanine aminotransferase (ALT) from 37 U/L to 59 U/L, respectively. Total bilirubin (T-BiL) increased until day 3 from 5.2 mg/dL to 12.6 mg/dL. On day 11, however, transaminases peaked again (AST, 268 U/L; ALT, 115 U/L) and total bilirubin was also rising | A case of cholestatic liver injury in the early stages of favipiravir treatment for COVID-19. Based on the CIMOS/RUCAM scoring system, it was classified as a cholestatic liver injury, with a score of 6 (possible) |
Leegwater et al[28] | Case report; The Netherlands | A 64-yr-old male patient. History of hypertension and hypercholesterolemia | Remdesivir | 5 d after start of remdesivir ALT was 1305 IU/L, AST 1461 U/L, alkaline phosphatase 269 U/L, total bilirubin 8 µmol/L, gammaglutamyltransferase 227 U/L and creatine kinase 103 U/L | Remdesivir toxicity was suspected based on the time-relation, the positive dechallenge, the known in vitro toxicity of remdesivir and the absence of alternative causes of hepatotoxicity. After stop of remdesivir the ALT/AST ratio reached normal values |
- Citation: Ortiz GX, Lenhart G, Becker MW, Schwambach KH, Tovo CV, Blatt CR. Drug-induced liver injury and COVID-19: A review for clinical practice. World J Hepatol 2021; 13(9): 1143-1153
- URL: https://www.wjgnet.com/1948-5182/full/v13/i9/1143.htm
- DOI: https://dx.doi.org/10.4254/wjh.v13.i9.1143