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Elevated transaminases and off-label use: case report In an open-label and non-randomised study of 12 patients who had been admitted to a hospital in Italy between 16 March 2020 to 30 March 2020, a patient [age and sex not stated] was described, who exhibited elevated levels of transaminases (AST and ALT) during off-label treatment with baricitinib and lopinavir/ritonavir for coronavirus disease 2019 (COVID-19) pneumonia. The patient, who was admitted to a hospital in Italy with COVID-19 pneumonia, started receiving off-label lopinavir/ritonavir, along with off-label baricitinib tablets 4 mg/day scheduled to be administered for 2 weeks [not all dosages stated; routes not stated]. Subsequently, the patient exhibited elevated levels of transaminases (AST was 267 U/L and ALT was 298 U/L), which was suspected to be drug-related [times to reactions onsets not stated]. The woman’s treatment was discontinued after 10 days, due to persistently elevated transaminases levels. It was later determined that, the elevated transaminases levels were probably related to the antiviral therapy with lopinavir/ritonavir rather than baricitinib [outcomes not stated]. Cantini F, et al. Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. Journal of Infection 81: 318-356, No. 2, Aug 2020. Available from: URL: http:// 803498649 doi.org/10.1016/j.jinf.2020.04.017

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Reactions 29 Aug 2020 No. 1819