Drug-induced liver injury in COVID-19 treatment: Incidence, mechanisms and clinical management

Xichuan Li; Wanting Wang; Suying Yan; Weipeng Zhao; Hui Xiong; Cuiping Bao; Jinqian Chen; Yuan Yue; Yanjun Su; Chunze Zhang

doi:10.3389/fphar.2022.1019487

Drug-induced liver injury in COVID-19 treatment: Incidence, mechanisms and clinical management

Front Pharmacol. 2022 Nov 28:13:1019487. doi: 10.3389/fphar.2022.1019487. eCollection 2022.

Authors

Xichuan Li¹, Wanting Wang^{2

3}, Suying Yan^{2

3}, Weipeng Zhao⁴, Hui Xiong⁵, Cuiping Bao⁶, Jinqian Chen⁷, Yuan Yue¹, Yanjun Su⁸, Chunze Zhang²

Affiliations

¹ Tianjin Key Laboratory of Animal and Plant Resistance, College of Life Sciences, Tianjin Normal University, Tianjin, China.
² Department of Colorectal Surgery, Tianjin Institute of Coloproctology, The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.
³ Tianjin University of Traditional Chinese Medicine, Tianjin, China.
⁴ Department of Breast Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
⁵ School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
⁶ Departments of Radiology, Tianjin Union Medical Center, Tianjin, China.
⁷ Departments of Pharmacy, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin, China.
⁸ Department of Lung Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.

Abstract

The COVID-19 outbreak triggered a serious and potentially lethal pandemic, resulting in massive health and economic losses worldwide. The most common clinical manifestations of COVID-19 patients are pneumonia and acute respiratory distress syndrome, with a variety of complications. Multiple organ failure and damage, ultimately leading to patient death, are possible as a result of medication combinations, and this is exemplified by DILI. We hope to summarize DILI caused by the antiviral drugs favipiravir, remdesivir, lopinavir/ritonavir, and hydroxychloroquine in COVID-19 patients in this review. The incidence of liver injury in the treatment of COVID-19 patients was searched on PubMed to investigate DILI cases. The cumulative prevalence of acute liver injury was 23.7% (16.1%-33.1%). We discuss the frequency of these events, potential mechanisms, and new insights into surveillance strategies. Furthermore, we also describe medication recommendations aimed at preserving DILI caused by treatment in COVID-19 patients.

Keywords: COVID-19; clinical management; drug-induced liver injury; incidence; mechanisms.

Publication types

Review