Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2020; 26(46): 7272-7286
Published online Dec 14, 2020. doi: 10.3748/wjg.v26.i46.7272
Challenges in COVID-19 drug treatment in patients with advanced liver diseases: A hepatology perspective
Amr Shaaban Hanafy, Sherief Abd-Elsalam
Amr Shaaban Hanafy, Internal Medicine Department, Zagazig University, Zagazig 44519, Egypt
Sherief Abd-Elsalam, Department of Tropical Medicine, Tanta University, Tanta 35127, Egypt
Author contributions: Hanafy AS and Abd-Elsalam S contributed equally to this work; Hanafy AS and Abd-Elsalam S designed the research; Hanafy AS and Abd-Elsalam S reviewed the literature and wrote the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sherief Abd-Elsalam, MD, PhD, Assistant Professor, Department of Tropical Medicine, Tanta University, Elbahr Street, Tanta 35127, Egypt.
Received: October 11, 2020
Peer-review started: October 11, 2020
First decision: November 3, 2020
Revised: November 6, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: December 14, 2020

The global incidence of coronavirus disease 2019 (COVID-19) continues to increase despite health care efforts. The disease is caused by coronavirus 2 with high transmission and mortality rates. Little is known about the management of COVID-19 in advanced liver disease. The aim of work was to propose a plan for management of this drastic disease in case of this specific population with review of medications that could be suitable for advanced liver disease. All the guidelines and medications available for treatment of COVID-19 were reviewed with selection of the less toxic medications that could be used in advanced liver disease. Drugs suitable to manage COVID-19 in patients with liver disease might include remdesivir intravenously, nitazoxanide + sofosbuvir, ivermectin, tocilizumab, convalescent plasma, and low molecular weight heparin in certain situations. Advanced liver disease is associated with portal hypertension and splenomegaly with reduction of blood elements and immune dysfunction and impaired T cell function. Thus, when confronted by cytokine storm as an immune response to COVID-19, there may be an increase in the mortality rate of these patients. Through this review, a plan to treat COVID-19 in this special group of patients with advanced cirrhosis is proposed.

Keywords: Cirrhosis, COVID-19, Drugs, Advanced liver disease, Anticoagulation, Coagulopathy

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic put the health care systems of many countries under great pressure, and it has been particularly challenging because of the lack of prediction parameters and effective pharmacotherapies for treating COVID-19 in advanced liver disease. Here, we provided a stepwise approach to treat COVID-19 in advanced liver disease, hoping for its application in a multicenter research trial.