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Remdesivir Induced Liver Injury and Severe COVID-19 Infection

Received: 4 November 2020    Accepted: 13 November 2020    Published: 23 November 2020
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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.

Published in American Journal of Internal Medicine (Volume 8, Issue 6)
DOI 10.11648/j.ajim.20200806.18
Page(s) 285-288
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Remdesivir, COVID-19, Hepatotoxicity, Aminotransferase

References
[1] Helmy YA, Fawzy M, Elaswad A, Sobieh A, Kenney SP, Shehata AA. The COVID-19 Pandemic: A Comprehensive Review of Taxonomy, Genetics, Epidemiology, Diagnosis, Treatment, and Control. J Clin Med. 2020; 9 (4): 1225.
[2] Roberts CM, Levi M, McKee M, Schilling R, Lim WS, Grocott MPW. COVID-19: a complex multisystem disorder. Br J Anaesth. 2020; 125 (3): 238-242.
[3] Zhao D, Yao F, Wang L, et al. A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia with Other Pneumonias. Clin Infect Dis. 2020; 71 (15): 756-761.
[4] Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020; 40 (5): 998-1004.
[5] Agostini ML, Andres EL, Sims AC, et al. Coronavirus Susceptibility to the Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease. mBio. 2018; 9 (2): e00221-00218.
[6] Brown AJ, Won JJ, Graham RL, et al. Broad spectrum antiviral remdesivir inhibits human endemic and zoonotic deltacoronaviruses with a highly divergent RNA dependent RNA polymerase. Antiviral Res. 2019; 169: 104541.
[7] Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020; 30 (3): 269-271.
[8] Rochwerg B, Agarwal A, Zeng L, et al. Remdesivir for severe covid-19: a clinical practice guideline. BMJ (Clinical research ed). 2020; 370: m2924. doi: 10.1136/bmj.m2924. Accessed 2020/07//.
[9] National Guidelines on Clinical Management of Coronavirus Disease 2019 (COVID-19). In: Disease Control Division DGoHS, Ministry of Health & Family Welfare, Government of the People's Republic of Bangladesh, ed. Version 7.0 ed2020.
[10] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020; 395 (10223): 497-506.
[11] Guan W-j, Ni Z-y, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020; 382 (18): 1708-1720.
[12] Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. The Lancet Gastroenterology & Hepatology. 2020; 5 (5): 428-430.
[13] Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. 2020.
[14] Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 Days in Patients with Severe Covid-19. New England Journal of Medicine. 2020.
[15] Zampino R, Mele F, Florio LL, et al. Liver injury in remdesivir-treated COVID-19 patients. Hepatol Int. 2020; 14 (5): 881-883.
[16] Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020.
[17] Grein J, Ohmagari N, Shin D, et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med. 2020; 382 (24): 2327-2336.
[18] Kujawski SA, Wong KK, Collins JP, et al. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nature Medicine. 2020.
[19] Lescure F-X, Bouadma L, Nguyen D, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. The Lancet Infectious Diseases. 2020.
[20] Munster VJ, Feldmann F, Williamson BN, et al. Respiratory disease and virus shedding in rhesus macaques inoculated with SARS-CoV-2. BioRxiv. 2020.
Cite This Article
  • APA Style

    Chanchal Kumar Ghosh, S. M. Ali Hasan, Suman Dey. (2020). Remdesivir Induced Liver Injury and Severe COVID-19 Infection. American Journal of Internal Medicine, 8(6), 285-288. https://doi.org/10.11648/j.ajim.20200806.18

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    ACS Style

    Chanchal Kumar Ghosh; S. M. Ali Hasan; Suman Dey. Remdesivir Induced Liver Injury and Severe COVID-19 Infection. Am. J. Intern. Med. 2020, 8(6), 285-288. doi: 10.11648/j.ajim.20200806.18

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    AMA Style

    Chanchal Kumar Ghosh, S. M. Ali Hasan, Suman Dey. Remdesivir Induced Liver Injury and Severe COVID-19 Infection. Am J Intern Med. 2020;8(6):285-288. doi: 10.11648/j.ajim.20200806.18

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  • @article{10.11648/j.ajim.20200806.18,
      author = {Chanchal Kumar Ghosh and S. M. Ali Hasan and Suman Dey},
      title = {Remdesivir Induced Liver Injury and Severe COVID-19 Infection},
      journal = {American Journal of Internal Medicine},
      volume = {8},
      number = {6},
      pages = {285-288},
      doi = {10.11648/j.ajim.20200806.18},
      url = {https://doi.org/10.11648/j.ajim.20200806.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/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 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.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Remdesivir Induced Liver Injury and Severe COVID-19 Infection
    AU  - Chanchal Kumar Ghosh
    AU  - S. M. Ali Hasan
    AU  - Suman Dey
    Y1  - 2020/11/23
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajim.20200806.18
    DO  - 10.11648/j.ajim.20200806.18
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 285
    EP  - 288
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20200806.18
    AB  - 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 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.
    VL  - 8
    IS  - 6
    ER  - 

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Author Information
  • Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

  • Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

  • Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

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