Mohideen Haseeb, Hussain Hafsa, Dahiya Dushyant Singh, Wehbe Hisham
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Northeast Ohio Medical University, Rootstown, OH, USA.
J Clin Transl Hepatol. 2023 Feb 28;11(1):188-196. doi: 10.14218/JCTH.2022.00207. Epub 2022 Nov 4.
Selective androgen receptor modulators (SARMs) are a class of nonsteroidal drugs that are favored over anabolic androgenic steroids (AASs) for their tissue-selectivity and improved side-effect profile. These drugs have been evaluated for treatment of various diseases including muscle-wasting disorders, osteoporosis, and breast cancer. Despite lacking approval for therapeutic use, SARMs are widely used recreationally as performance enhancing drugs by bodybuilders and athletes. In recent years, cases of drug-induced liver injury (DILI) secondary to SARMs have begun to emerge, but little is known regarding their hepatotoxicity. In this review, we provide current knowledge regarding DILI from SARMs. A literature search was conducted regarding SARMs and liver injury to evaluate relevant cases and information. SARMs have been associated with a cholestatic syndrome congruent with that of DILI from AASs, and it consists of a bland cholestasis in which there is minimal bile duct injury, inflammation, or necrosis. Patients present with an insidious onset of jaundice with marked hyperbilirubinemia and mild hepatic enzyme elevations. No clear treatment exists, although patients typically show improvement with cessation of the offending SARM. Given the novelty of these drugs, further study is necessary to understand diagnosis, management, and complications of SARM-related DILI.
选择性雄激素受体调节剂（SARMs）是一类非甾体药物，因其组织选择性和改善的副作用特征而比合成代谢雄激素类固醇（AASs）更受青睐。这些药物已被评估用于治疗各种疾病，包括肌肉萎缩症、骨质疏松症和乳腺癌。尽管未获治疗用途批准，但SARMs被健美运动员和运动员广泛用于娱乐目的，作为提高成绩的药物。近年来，继发于SARMs的药物性肝损伤（DILI）病例开始出现，但关于其肝毒性知之甚少。在本综述中，我们提供了关于SARMs所致DILI的现有知识。我们针对SARMs和肝损伤进行了文献检索，以评估相关病例和信息。SARMs与一种与AASs所致DILI一致的胆汁淤积综合征相关，其表现为单纯性胆汁淤积，胆管损伤、炎症或坏死轻微。患者表现为隐匿性黄疸发作，伴有明显高胆红素血症和轻度肝酶升高。虽然患者通常在停用相关SARM后病情改善，但目前尚无明确的治疗方法。鉴于这些药物的新颖性，有必要进一步研究以了解SARM相关DILI的诊断、管理和并发症。
