Department of Pharmacy, Orlando Regional Medical Center, Orlando, Florida, USA.
Department of Critical Care Medicine, Orlando Regional Medical Center, Orlando, Florida, USA.
Pharmacotherapy. 2020 Nov;40(11):1166-1171. doi: 10.1002/phar.2464. Epub 2020 Oct 27.
Remdesivir is a direct-acting nucleoside RNA polymerase inhibitor with activity against the novel severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) virus used in the treatment of coronavirus disease 2019 (COVID-19) pneumonia. Here, we present two cases of suspected remdesivir-associated acute liver failure (ALF) in which the liver failure improved after continuous infusion acetylcysteine and withdrawal of remdesivir. Both patients had significant increases in transaminases between day 3 and day 10 of remdesivir therapy accompanied by coagulopathy and encephalopathy. After initiation of continuous infusion acetylcysteine, the transaminases of both patients rapidly improved. Ultimately, one patient fully recovered while the other died of suspected septic shock. Due to its novel nature and only recent widespread use, there are very little data on the risk of ALF from remdesivir. Additionally, the data for the use of acetylcysteine to manage non-acetaminophen-induced ALF are limited. It is important to consider the risk of remdesivir-associated ALF when weighing the risk versus benefits of use, and acetylcysteine may have a role in its management.
瑞德西韦是一种直接作用的核苷 RNA 聚合酶抑制剂，对新型严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）具有活性，用于治疗 2019 年冠状病毒病（COVID-19）肺炎。在这里，我们报告了两例疑似与瑞德西韦相关的急性肝衰竭（ALF）病例，在这两例病例中，连续输注乙酰半胱氨酸和停用瑞德西韦后，肝功能衰竭得到改善。这两例患者在接受瑞德西韦治疗的第 3 天至第 10 天期间，转氨酶显著升高，同时伴有凝血功能障碍和肝性脑病。开始连续输注乙酰半胱氨酸后，两名患者的转氨酶迅速改善。最终，一名患者完全康复，而另一名患者死于疑似感染性休克。由于其新颖性和最近才广泛使用，关于瑞德西韦引起 ALF 的风险的数据非常少。此外，用于治疗非乙酰氨基酚引起的 ALF 的乙酰半胱氨酸的数据也很有限。在权衡使用的风险与收益时，应考虑瑞德西韦相关的 ALF 风险，而乙酰半胱氨酸可能在其治疗中发挥作用。
