Remdesivir raises pancreatic enzyme levels in 1 in 10 COVID-19 patients

Coronavirus disease 2019 (COVID-19) patients treated with remdesivir appear to be at a higher likelihood of having elevated pancreatic enzyme levels, a recent Japan study has found.

“Therefore, we propose monitoring pancreatic enzyme levels in COVID-19 patients to detect the onset of pancreatitis during the course of remdesivir treatment for COVID-19,” the researchers said.

The current retrospective observational study included 201 COVID-19 patients (median age 73 years, 61.2 percent men) who had been treated with remdesivir, and of whom 177 ultimately recovered from the infection. Outcomes included acute pancreatitis or a grade ≥3 increase in pancreatic enzyme levels.

Twenty-three patients (11.4 percent) saw a grade ≥3 increase in pancreatic enzyme levels, occurring a median of 5 days after remdesivir administration. Amylase and lipase levels were raised more than three times the upper limit of the normal range in six and 21 patients, respectively. One patient saw a similarly strong elevation in the levels of both amylase and lipase.

The percentage of patients with grade ≥3 elevation in pancreatic enzyme levels was significantly greater in the remdesivir-treated subgroup (p=0.001), as in those who were treated with steroids (p=0.008) or those who had critical COVID-19 (p=0.000).

Logistic regression analysis confirmed that remdesivir use was indeed a significant risk factor for grade ≥3 elevation in pancreatic enzyme levels or acute pancreatitis onset (hazard ratio [HR], 4.565, 95 percent confidence interval [CI], 1.113–18.724; p=0.035), as was having had critical COVID-19 (HR, 10.137, 95 percent CI, 3.631–28.299; p=0.000).