Hepatotoxicity in rheumatological patients: features of the course, possibilities of correction

Аuthors: E.V. Maksymova, I.L. Klyarytskaya

Background

Drug-induced liver disease (DILD) is a variety of clinical and morphological variants of liver disease that develop in response to the medication. Significant difficul­ties in diagnostics and treatment of these conditions are caused by a large number of potentially hepatotoxic drugs, as well as the diversity of spectrum of DILD. So far, there are no clear criteria for clinical, laboratory and morphological diagnosis of DILD; unified classification, treatment standards are not developed yet.

Objective

To study the effectiveness of various schemes of ursodeoxycholic acid (UDCA) (the drug “Choludexan”) in the treatment of the manifestations of DILD in rheumatoid arthritis (RA) patients on long-term methotrexate therapy.

Materials and methods

Patients with verified DILD and RA on long-term methotrexate therapy were randomized into 3 groups: group 1 (n=15) had been receiving “Cholu­dexan” 15 mg/kg day for 2 months; group 2 (n=15) had been receiving “Choludexan” 20 mg/kg day for 2 months.; group 3 (control group) (n = 15) had been receiving only standart treatment of RA (methotrexate therapy). The diagnosis of DILD was based on comprehensive clinical and laboratory examination including determination of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, determination of proinflammatory cytokines (TNF-alpha and IL-6), critical flicker frequency test (identification of hepatic encephalopathy), ¹³C-methacetin breath test (identification of liver detoxification function).

Conclusions

The drug “Choludexan” was found to be effective in patients with RA and DILD, has a positive effect on biochemical parameters (ALT, AST, ALP, bilirubin), the degree of hepatic encephalopathy and the degree of impairment of liver detoxification function. Choludexan dose 20 mg/kg was more effective than 15 mg/kg.

Key words: drug-induced liver disease, ursodeoxycholic acid, interleukin-6, tumor ne­crosis factor-alpha, ¹³C-methacetin breath test.

Published in ’2015