Department of Biomedical, Metabolic and Neural Sciences, Operating Unit of Internal and Metabolic Medicine, Azienda Ospedaliero-Universitaria of Modena and University of Modena and Reggio Emilia, Civil Hospital of Baggiovara, Modena, Italy.
Operating Unit of Internal and Metabolic Medicine, Azienda Ospedaliero-Universitaria of Modena, Civil Hospital of Baggiovara, Modena, Italy.
J Basic Clin Physiol Pharmacol. 2021 Apr 22;32(6):1151-1155. doi: 10.1515/jbcpp-2021-0013.
Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported.
We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI.
In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.
他汀类药物已被证明可降低高危人群的心血管发病率和死亡率，且通常耐受性良好，尽管可能会出现不良反应。高达 3%的患者会出现转氨酶升高，通常继续治疗即可恢复正常，且很少与临床症状相关。严重的他汀类药物相关肝损伤极为罕见。此外，关于再次使用第二种他汀类药物的文献极为有限。一些作者警告说，再次接触这些药物会导致更严重的肝损伤，但也有报道称在药物性肝损伤（DILI）后安全地转换为第二种他汀类药物。
我们描述了一例中年女性在辛伐他汀剂量增加后发生肝细胞性肝损伤的病例；再次使用低剂量瑞舒伐他汀导致 DILI 迅速复发。
在我们看来，当尝试再次使用另一种他汀类药物时，临床医生在再次用药时应非常谨慎，并密切随访发生他汀类药物相关肝损伤的患者。
