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Article: Safety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitis

TitleSafety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitis
Authors
Issue Date2000
PublisherPacini Editore SpA. The Journal's web site is located at http://www.clinexprheumatol.org
Citation
Clinical And Experimental Rheumatology, 2000, v. 18 n. 3, p. 363-368 How to Cite?
AbstractObjective - To examine the safety of the use of disease modifying anti- rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients with chronic vital hepatitis (CVH). Methods - Records of 600 Chinese patients satisfying the ARA criteria for RA in two rheumatology centers were reviewed. Patients with CVH were studied. Liver enzymes were checked before (baseline) and during DMARD use at 3-month intervals or more frequently if necessary. Drug- episodes (D-Ep), defined as the continuous use of DMARD, singly or in combination, for more than 6 months in a patient, were analysed. Changes in serum liver alanine transaminase (ALT) levels as multiples of the upper range of normal were taken to reflect the severity of hepatotoxicity. Changes of ALT to ≥ 1.5 times the upper range of normal if they were measured at baseline or ≥ 2 times the upper range of normal if they were measured during and after the use of DMARD were considered as abnormal. Control patients included those with CVH alone (n = 623) or RA without CVH (n = 62) matched for age, sex and D-Ep. Results - 30 RA patients were found to have concomitant CVH. One patient was excluded because of use of NSAID alone (n = 1). Among the 29 patients, 23 were HBsAg +ve and 6 were anti-HCVAb +ve. A total of 47 D-Ep were analysed. 20/47 (42.6%) of D-Ep in 16/29 (55.2%) RA +CVH patients developed abnormal ALT levels after a mean 1.9-year duration of DMARD use. This was statistically significant when compared with 13/94 (13.8%) of D-Ep which ended with abnormal ALT levels in 13/62 (21%) patients with RA alone (p < 0.0001 for D-Ep which ended up with abnormal ALT, and p < 0.02 for the number of patients who developed abnormal ALT) and 128/623 (20.5%) patients with CVH alone (p < 0.005). 53% (9/17) of hydroxychloroquine (HCQ) D-Ep were associated with an abnormal outcome. Corresponding figures for sulphasalazine (SAZP) and oral or intramuscular gold preparations were 55.6% (5/9) and 0% (0/3) respectively. Two patients on methotrexate, used either singly or in combination, had normal ALT levels throughout the study period. One patient on azathioprine developed reactivation of hepatitis B infection. When D-Ep of the RA +CVH group were further analysed, 16/43 (37.2%) and 4/4 (100%) D-Ep which started with normal and abnormal baseline ALT respectively developed further liver enzyme derangement. Conclusion - The use of DMARD in RA +CVH patients is associated with a high incidence of hepatotoxicity. The effect is likely to be synergistic. This includes drugs such as HCQ, which is generally believed to be less hepatotoxic.
Persistent Identifierhttp://hdl.handle.net/10722/162414
ISSN
2015 Impact Factor: 2.495
2015 SCImago Journal Rankings: 0.953
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMok, MYen_US
dc.contributor.authorNg, WLen_US
dc.contributor.authorYuen, MFen_US
dc.contributor.authorWong, RWSen_US
dc.contributor.authorLau, CSen_US
dc.date.accessioned2012-09-05T05:19:43Z-
dc.date.available2012-09-05T05:19:43Z-
dc.date.issued2000en_US
dc.identifier.citationClinical And Experimental Rheumatology, 2000, v. 18 n. 3, p. 363-368en_US
dc.identifier.issn0392-856Xen_US
dc.identifier.urihttp://hdl.handle.net/10722/162414-
dc.description.abstractObjective - To examine the safety of the use of disease modifying anti- rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients with chronic vital hepatitis (CVH). Methods - Records of 600 Chinese patients satisfying the ARA criteria for RA in two rheumatology centers were reviewed. Patients with CVH were studied. Liver enzymes were checked before (baseline) and during DMARD use at 3-month intervals or more frequently if necessary. Drug- episodes (D-Ep), defined as the continuous use of DMARD, singly or in combination, for more than 6 months in a patient, were analysed. Changes in serum liver alanine transaminase (ALT) levels as multiples of the upper range of normal were taken to reflect the severity of hepatotoxicity. Changes of ALT to ≥ 1.5 times the upper range of normal if they were measured at baseline or ≥ 2 times the upper range of normal if they were measured during and after the use of DMARD were considered as abnormal. Control patients included those with CVH alone (n = 623) or RA without CVH (n = 62) matched for age, sex and D-Ep. Results - 30 RA patients were found to have concomitant CVH. One patient was excluded because of use of NSAID alone (n = 1). Among the 29 patients, 23 were HBsAg +ve and 6 were anti-HCVAb +ve. A total of 47 D-Ep were analysed. 20/47 (42.6%) of D-Ep in 16/29 (55.2%) RA +CVH patients developed abnormal ALT levels after a mean 1.9-year duration of DMARD use. This was statistically significant when compared with 13/94 (13.8%) of D-Ep which ended with abnormal ALT levels in 13/62 (21%) patients with RA alone (p < 0.0001 for D-Ep which ended up with abnormal ALT, and p < 0.02 for the number of patients who developed abnormal ALT) and 128/623 (20.5%) patients with CVH alone (p < 0.005). 53% (9/17) of hydroxychloroquine (HCQ) D-Ep were associated with an abnormal outcome. Corresponding figures for sulphasalazine (SAZP) and oral or intramuscular gold preparations were 55.6% (5/9) and 0% (0/3) respectively. Two patients on methotrexate, used either singly or in combination, had normal ALT levels throughout the study period. One patient on azathioprine developed reactivation of hepatitis B infection. When D-Ep of the RA +CVH group were further analysed, 16/43 (37.2%) and 4/4 (100%) D-Ep which started with normal and abnormal baseline ALT respectively developed further liver enzyme derangement. Conclusion - The use of DMARD in RA +CVH patients is associated with a high incidence of hepatotoxicity. The effect is likely to be synergistic. This includes drugs such as HCQ, which is generally believed to be less hepatotoxic.en_US
dc.languageengen_US
dc.publisherPacini Editore SpA. The Journal's web site is located at http://www.clinexprheumatol.orgen_US
dc.relation.ispartofClinical and Experimental Rheumatologyen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAlanine Transaminase - Blooden_US
dc.subject.meshAntirheumatic Agents - Toxicityen_US
dc.subject.meshArthritis, Rheumatoid - Drug Therapy - Virologyen_US
dc.subject.meshDrug-Induced Liver Injury - Virologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHepatitis B, Chronic - Complicationsen_US
dc.subject.meshHepatitis C, Chronic - Complicationsen_US
dc.subject.meshHumansen_US
dc.subject.meshLiver - Drug Effects - Enzymology - Virologyen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshRetrospective Studiesen_US
dc.titleSafety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitisen_US
dc.typeArticleen_US
dc.identifier.emailMok, MY:temy@hkucc.hku.hken_US
dc.identifier.emailYuen, MF:mfyuen@hkucc.hku.hken_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityMok, MY=rp00490en_US
dc.identifier.authorityYuen, MF=rp00479en_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid10895374-
dc.identifier.scopuseid_2-s2.0-0034047941en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034047941&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume18en_US
dc.identifier.issue3en_US
dc.identifier.spage363en_US
dc.identifier.epage368en_US
dc.identifier.isiWOS:000087688900009-
dc.publisher.placeItalyen_US
dc.identifier.scopusauthoridMok, MY=7006024184en_US
dc.identifier.scopusauthoridNg, WL=7401613401en_US
dc.identifier.scopusauthoridYuen, MF=7102031955en_US
dc.identifier.scopusauthoridWong, RWS=34875928200en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US

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