Gastrointestinal and hepatic side effects of potential treatment for COVID-19 and vaccination in patients with chronic liver diseases

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) is a global pandemic. Many clinical trials have been performed to investigate potential treatments or vaccines for this disease to reduce the high morbidity and mortality. The drugs of higher interest include umifenovir, bromhexine, remdesivir, lopinavir/ritonavir, steroid, tocilizumab, interferon alpha or beta, ribavirin, fivapiravir, nitazoxanide, ivermectin, molnupiravir, hydroxychloroquine/chloroquine alone or in combination with azithromycin, and baricitinib. Gastrointestinal (GI) symptoms and liver dysfunction are frequently seen in patients with COVID-19, which can make it difficult to differentiate disease manifestations from treatment adverse effects. GI symptoms of COVID-19 include anorexia, dyspepsia, nausea, vomiting, diarrhea and abdominal pain. Liver injury can be a result of systemic inflammation or cytokine storm, or due to the adverse drug effects in patients who have been receiving different treatments. Regular monitoring of liver function should be performed. COVID-19 vaccines have been rapidly developed with different technologies including mRNA, viral vectors, inactivated viruses, recombinant DNA, protein subunits and live attenuated viruses. Patients with chronic liver disease or inflammatory bowel disease and liver transplant recipients are encouraged to receive vaccination as the benefits outweigh the risks. Vaccination against COVID-19 is also recommended to family members and healthcare professionals caring for these patients to reduce exposure to the severe acute respiratory syndrome coronavirus 2 virus.

Strategies for the development and approval of COVID-19 vaccines and therapeutics in the post-pandemic period

“…Although Lopinavir exhibits some antiviral activity, its association with hepatotoxicity must also be considered. 80 Paxlovid, targeting the M-pro in the SARS-CoV-2 genome, is highly recommended for COVID-19 treatment due to its sustained antiviral efficacy against emerging Omicron subvariants. 78,81 Administering Paxlovid during the early stages of infection can significantly reduce hospitalization rates by 89% in high-risk patients.…”

COVID‐19‐associated liver injury: Adding fuel to the flame

“…54 According to a report, the prevalence of COVID-19 among LT candidates is 6.05%, which is twice that of the general population. 55 Although some studies hold the opinion that the severity of COVID-19 in LT patients is similar to or even lower than that of the general population, serum ALP levels and lymphovascular infiltration among HCC patients produced significant differences between the prepandemic and pandemic periods in a research of United States, which means worse prognosis after LT. 56,57 More research illustrated that the different course of COVID-19 among LT patients may be related to the patient age, gender, • Diarrhea, nausea, and dizziness [41] Chloroquine or hydroxychloroquine and/or azithromycin Antimalarial drug; heme polymerase inhibitor • Aggravate the existing liver injury; accumulate in the liver [36,42] • Elevated ALT, AST level, or bilirubin level Interferons A family of cytokines • Nausea, fatigue, elevated transaminases [41,43] • Autoimmune hepatitis Ivermectin An antiparasitic drug • Dizziness, nausea, or diarrhea [41,44,45] • Elevation of liver enzymes…”

Drug-Induced Liver Injury in Hospitalized Patients during SARS-CoV-2 Infection

“…Most common side effects include headache, insomnia, and an increase in ALT, and medical professionals should be careful when administering molnupiravir to patients with hepatic dysfunction. However, it is not associated with clinically apparent liver injury [59,60].…”