Transient liver enzyme derangement following Remdesivir use: a case series

Case Series

  • Harsh H. Patel Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
  • Harsha D. Makwana Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.
  • Karan B. Shah Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
  • Supriya D. Malhotra Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
Keywords: Remdesivir, Liver enzyme elevation, Drug-induced liver injury (DILI), De-challenge

Abstract

Remdesivir, a nucleotide analog RNA polymerase inhibitor, which was originally evaluated in clinical trials to thwart the Ebola outbreak in 2014, has shown in vitro efficacy against SARS-CoV-2. Experience on its efficacy and safety in COVID-19 is accumulating. In COVID-19, Remdesivir therapy is given intravenously for 5 to 10 days and is frequently accompanied by transient, reversible mild-to-moderate elevations in serum aminotransferase levels but has been only rarely linked to instances of clinically apparent liver injury as a drug-induced liver injury (DILI). It may be caused by direct toxicity possibly due to inhibition of mitochondrial RNA polymerase. Here, we have discussed two cases where liver enzyme levels increased dramatically on the day next after initiating Remdesivir. Case one and two showed grade 4 and grade 3 hepatotoxicity respectively. In both cases, a positive de-challenge was observed and concomitant drugs were not considered to be confounders.  Hence, Remdesivir has a causal relationship with the occurrence of this adverse drug reaction.

Author Biographies

Harsh H. Patel, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Resident Doctor, M. D. (Pharmacology), Department of Pharmacology,

Harsha D. Makwana, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India.

Associate Professor, Department of Emergency Medicine

Karan B. Shah, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

Junior Lecturer, Department of Pharmacology

Supriya D. Malhotra, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

Professor and Head, Department of Pharmacology

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Published
2021-09-01
How to Cite
1.
PATEL H, Makwana H, Shah K, Malhotra S. Transient liver enzyme derangement following Remdesivir use: a case series. jpadr [Internet]. 2021Sep.1 [cited 2021Sep.18];2(3):31-4. Available from: http://jpadr.com/index.php/jpadr/article/view/34