UGC Digestivo y Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), H U Virgen de la Victoria, Malaga, Spain.
Department of Toxicology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
United European Gastroenterol J. 2019 Jul;7(6):825-837. doi: 10.1177/2050640619840147. Epub 2019 Mar 24.
Corticosteroids are often empirically used to treat idiosyncratic hepatotoxicity with severe features. Interestingly, intravenous methylprednisolone (MP) is increasingly being recognized as being responsible for liver injury. We aimed to characterize MP-induced liver injury by analyzing demographical, clinical, laboratory and outcome data of three MP-induced hepatotoxicity cases and compared this information with that of previously published cases.
Three females with multiple sclerosis (MS) were treated intravenously with MP, mean daily dose 767 mg. Liver damage occurred 2 to 6 weeks after exposure. Severity was mild to moderate. Two patients suffered positive rechallenge.
We identified 50 published cases of MP hepatotoxicity. Most of these cases were female (86%) and main treatment indications were MS (29 cases) and Graves' ophthalmopathy (13 cases). Hepatocellular damage predominated and mean time to onset was 6 weeks. Four patients died and rechallenge occurred in 19 cases.
MP pulses can induce severe liver injury, often with an autoimmune phenotype, particularly in patients with MS and Graves' ophthalmopathy. Consequently, these patient groups should have liver tests monitored when treated with MP to provide safer patient care.
皮质类固醇常被经验性地用于治疗具有严重特征的特发性肝毒性。有趣的是，静脉注射甲基强的松龙（MP）越来越被认为是导致肝损伤的原因。我们旨在通过分析三例 MP 诱导的肝毒性病例的人口统计学、临床、实验室和结局数据来描述 MP 诱导的肝损伤，并将这些信息与以前发表的病例进行比较。
3 名患有多发性硬化症（MS）的女性接受 MP 静脉注射治疗，平均日剂量为 767mg。暴露后 2 至 6 周出现肝损伤。严重程度为轻度至中度。两名患者出现阳性再挑战。
我们确定了 50 例已发表的 MP 肝毒性病例。这些病例大多为女性（86%），主要治疗指征为 MS（29 例）和格雷夫斯眼病（13 例）。肝实质细胞损伤为主，发病时间平均为 6 周。4 例患者死亡，19 例出现再挑战。
MP 脉冲可引起严重肝损伤，常伴有自身免疫表型，特别是在 MS 和格雷夫斯眼病患者中。因此，当这些患者群体接受 MP 治疗时，应监测肝试验，以提供更安全的患者护理。
