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World J Hepatol. Sep 27, 2021; 13(9): 1143-1153
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1143
Drug-induced liver injury and COVID-19: A review for clinical practice
Gabriela Xavier Ortiz, Gabriele Lenhart, Matheus William Becker, Karin Hepp Schwambach, Cristiane Valle Tovo, Carine Raquel Blatt
Gabriela Xavier Ortiz, Matheus William Becker, Karin Hepp Schwambach, Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Gabriele Lenhart, Multiprofessional Residency Integrated in Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Cristiane Valle Tovo, Internal Medicine Department, Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Carine Raquel Blatt, Pharmacoscience Department, Graduate Program in Medicine-Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Author contributions: Ortiz GX, Lenhart G, Becker MW and Schwambach KH collected the data and wrote the paper; Blatt CR wrote and revised the paper; Tovo CV performed the final review of the manuscript with significant contributions; all authors approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matheus William Becker, MSc, Pharmacist, Research Scientist, Graduate Program in Medicine Hepatology, Federal University of Health Sciences of Porto Alegre, Sarmento Leite, 245 Street, Porto Alegre 90050-170, Rio Grande do Sul, Brazil. matheuswbecker@gmail.com
Received: May 8, 2021
Peer-review started: May 8, 2021
First decision: May 13, 2021
Revised: May 18, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: September 27, 2021
Abstract

Coronavirus disease 2019 (COVID-19) consists of a systemic disease that can present many complications. The infection presents broad clinical symptoms and a high rate of transmissibility. In addition to severe acute respiratory syndrome, the patients manifest complications beyond the respiratory system. The frequency of liver damage in COVID-19 patients ranges from 14.8% to 53% of patients. One should pay attention to drug-induced liver injury (DILI) in patients with COVID-19, especially considering the off-label use of drugs in prophylactic and therapeutic regimens applied on large scales. This review aims to present relevant information on the medication used so far in COVID-19 patients and its possible hepatotoxicity. We reviewed liver damage in patients with COVID-19 on PubMed and Virtual Health Library to investigate DILI cases. Four studies were selected, involving the medicines remdesivir, tocilizumab and a pharmacovigilance analysis study. The hepatotoxicity profile of drugs presented in the literature considers use in accordance to usual posology standards for treatment. However, drugs currently used in the management of COVID-19 follow different dosages and posology than those tested by the pharmaceutical industry. The deficiency of uniformity and standardization in the assessment of hepatotoxicity cases hinders the publication of information and the possibility of comparing information among healthcare professionals. It is suggested that severe liver injury in COVID-19 patients should be reported in pharmacovigilance institutions, and physicians should pay attention to any considerable abnormal liver test elevation as it can demonstrate unknown drug hepatotoxicity. Liver disorders in COVID-19 patients and the use of several concomitant off-label medications — with a potential risk of further damaging the liver - should at least be a warning sign for rapid identification and early intervention, thus preventing liver damage from contributing to severe impairment in patients.

Keywords: Liver injury, Chemical and drug-induced liver injury, COVID-19, SARS-CoV-2, Pharmacovigilance

Core Tip: Coronavirus disease 2019 (COVID-19) is a multisystemic disease, and liver manifestations are an important aspect to be considered. One should pay attention to drug-induced liver injury, especially considering the off-label use of drugs in prophylactic and therapeutic regimens applied on large scales. A review of liver damage in patients with COVID-19 returned three studies involving remdesivir, tocilizumab, and a pharmacovigilance study. Liver disorders in COVID-19 patients and the use of several concomitant off-label drugs - potentially causing further liver damage - should be a warning sign for rapid identification and early intervention, thus preventing severe impairment in patients.