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Azathioprine and 6-Mercaptopurine-induced Liver Injury: Clinical Features and Outcomes
- Publication Year :
- 2017
- Publisher :
- The University of North Carolina at Chapel Hill University Libraries, 2017.
-
Abstract
- Objective The objective of the study was to define the clinical, biochemical, and histologic features of liver injury from thiopurines. Background Azathioprine (Aza) and 6-mercaptopurine (6-MP) can cause liver injury, but no large series exist. Methods Clinical and laboratory data and 6-month outcomes of patients with thiopurine hepatotoxicity from the Drug-Induced Liver Injury Network Prospective Study were analyzed. Results Twenty-two patients were identified, 12 due to Aza and 10 due to 6-MP, with a median age of 55 years; the majority were female (68%). Inflammatory bowel disease was the indication in 55%, and the median thiopurine dose was 150 (range, 25 to 300) mg daily. The median latency to onset was 75 (range, 3 to 2584) days. Injury first arose after a dose escalation in 59% of patients, the median latency after dose increase being 44 (range, 3 to 254) days. At onset, the median alanine aminotransferase level was 210 U/L, alkaline phosphatase was 151 U/L, and bilirubin was 7.4 mg/dL (peak, 13.4 mg/dL). There were no major differences between Aza and 6-MP cases, but anicteric cases typically had nonspecific symptoms and a hepatocellular pattern of enzyme elevations, whereas icteric cases experienced cholestatic hepatitis with modest enzyme elevations in a mixed pattern. One patient with preexisting cirrhosis required liver transplantation; all others resolved clinically. One patient still had moderate alkaline phosphatase elevations 2 years after onset. Conclusions Nearly three-quarters of patients with thiopurine-induced liver injury present with self-limited, cholestatic hepatitis, typically within 3 months of starting or a dose increase. The prognosis is favorable except in patients with preexisting cirrhosis.
- Subjects :
- Male
Cirrhosis
Time Factors
Databases, Factual
medicine.medical_treatment
Azathioprine
Liver transplantation
Pharmacology
Gastroenterology
0302 clinical medicine
Prospective Studies
Prospective cohort study
Child
Liver injury
Cholestasis
Thiopurine methyltransferase
biology
Mercaptopurine
food and beverages
Alanine Transaminase
Middle Aged
030220 oncology & carcinogenesis
Alkaline phosphatase
030211 gastroenterology & hepatology
Female
lipids (amino acids, peptides, and proteins)
Chemical and Drug Induced Liver Injury
medicine.drug
Adult
medicine.medical_specialty
Adolescent
Article
03 medical and health sciences
Young Adult
Internal medicine
parasitic diseases
medicine
Humans
Aged
business.industry
urogenital system
Bilirubin
medicine.disease
Alkaline Phosphatase
Inflammatory Bowel Diseases
carbohydrates (lipids)
biology.protein
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....a7d95ac8cd9f8c0b00391cb368c60890
- Full Text :
- https://doi.org/10.17615/bdxj-8p74