Hepatotoxicita IBD liečby

Autori: Koller T., Galambošová M., Fiľakovská S., Kubincová M., Tóth J., Hlavatý T., Payer J.

Pracovisko: V. interná klinika Lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice Bratislava


Drug induced liver injury (DILI) is the most common cause of acute liver injury. IBD patients might have an increased risk of DILI due to long-term treatment, multiple therapies and altered nutritional status. Any liver injury during IBD treatment might further compromise treatment choices and efficacy.

First, prospectively evaluate on-treatment prevalence, severity and evolution of liver injury in IBD patients for 6 months. Second, evaluate the impact of IBD treatment on the prevalence of liver injury. Third, evaluate implications for further IBD therapy.

From 1/1/2014 to 1/6/2014 all IBD cases visiting a single center were included. Demographics, IBD status, IBD therapy and possible PSC were recorded. Liver blood tests were measured at three time points 3 months apart. Liver injury was defined as elevated ALT, GGT and ALP above 1,5 times the upper limit of normal (ULN). Two types of liver injury were predefined: transient elevation (once or twice) and persisting elevation (at all three time points). Severe liver injury was defined as ALT> 5xULN at any time. The prevalence of hepatotoxicity was compared among various treatment groups (no azathioprine, no anti TNF (1), azathioprine (AZA) solo (2), anti TNF solo (3), and combination therapy (4). Finally, we evaluated the need for change in IBD therapy caused by liver injury.

205 IBD patients were included, with median age of 40, M/F ratio 102/103, Crohn´s/UC ratio 127/78, 27% with prior GI resection, 2 cases with PSC. IBD was treated with no AZA and no anti TNF in 40 cases, azathioprine solo in 40 cases, anti TNF solo in 63 cases and combination therapy in 62 cases. For 6 months, transient ALT elevation was observed in 18 cases (8.78%), GGT in 21 cases (10.24%) and ALP in 5 cases (2.44%). Persisting ALT elevation was observed in 2 cases (0.98%), GGT in 3 cases (1.46%) and none of ALP.  Severe liver injury was observed in 1 case (0.49%). The prevalence of transient liver injury among the 4 treatment groups  was 5 vs. 10 vs. 12,7 vs. 9,6% for ALT and 12,5 vs. 17,5 vs. 15,9 vs. 3,2% for GGT and was not statistically different. Liver injury did not result in any change of IBD therapy.

Liver injury in treated IBD patients was relatively common (~10%). However, it was mostly transient, non-severe and rarely (~1%) persisted for 6 month. IBD therapy did not increase the risk of liver injury. No resulting changes in IBD treatment were needed.