Hepatotoxicity after high‐dose intravenous methylprednisolone in multiple sclerosis patients

Abstract

Key Clinical MessageHepatotoxicity is a rare adverse event of methylprednisolone that should be considered in clinical practice. In patients at risk, we propose liver function surveillance, by measuring hepatic enzymes concentration 15–30 days after methylprednisolone administration. Additionally, we propose ACTH, dexamethasone, or plasma exchange as alternate treatment options for these patients.

Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

“…To date a limited number of cases of methylprednisolone-induced hepatotoxicity had been described 7 10–24. We report an idiosyncratic toxic hepatitis from high-dose methylprednisolone in a 16-year-old girl.…”

“…The combination of clinical, laboratory and histological data suggested a diagnosis of methylprednisolone-induced toxic hepatitis. The side effect in this patient was specific for high-dose methylprednisolone,12 and it was classified as ‘probable adverse drug reaction’ 21…”

“…However, perhaps not everyone knows the toxic damages to the liver due to methylprednisolone. Hepatotoxicity from HDCS had been described 7 10–24. This condition was related to immunomodulator drugs, autoimmune or viral agents, until recently when the relation between methylprednisolone therapy and hepatotoxicity had been proven 21 25.…”

Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

“…To the best of our knowledge, this is the first prospective observation study on methylprednisolone hepatotoxicity in a population of patients with MS, so it is not possible to make direct comparisons with previous work in the literature reporting hepatotoxicity cases as adverse event of methylprednisolone administration in MS (Hidalgo de la Cruz et al., ). Eguci and coworkers described a prevalence of 45% of ALT increase and of 4% of severe liver dysfunction in a cohort of 175 Japanese patients treated with methylprednisolone pulse therapy for Graves’ ophthalmopathy, but they included many patients with chronic HBV or HCV hepatitis (Eguchi et al., ).…”

“…High-dose pulsed methylprednisolone treatment has been also associated with liver injury. By reviewing the literature published in English, we found a total of forty-seven cases of methylprednisolonerelated liver injury, including patients treated for diseases other than MS (Carrier et al, 2013;D'Agnolo & Drenth, 2013;Das, Graham, & Rose, 2006;Davidov et al, 2016;Dourakis, Sevastianos, & Kaliopi, 2002;Dumortier et al, 2017;Eguchi et al, 2015;Ferraro et al, 2015;Furutama et al, 2011;Gerolami et al, 1997;Grilli, Galati, Petrosillo, Del Nonno, & Baiocchini, 2015;Gutkowski, Chwist, & Hartleb, 2011;Hidalgo de la Cruz et al, 2017;Hofstee, Nanayakkara, & Stehouwer, 2005;Loraschi et al, 2010;Maàmouri et al, 2009;Marinó et al, 2004;Melamud, Lurie, Goldin, Levi, & Esayag, 2014;Moleti et al, 2016;Nanki, Koike, & Miyasaka, 1999;Oliveira, Lopes, Cipriano, & Sofia, 2015;Reuβ, Retzlaff, Vogel, Franke, & Oschmann, 2007;Rivero Fernández et al, 2008;Salvi et al, 2004;Takahashi et al, 2008;Topal et al, 2006;Weissel & Hauff, 2000). The aim of this prospective study was to evaluate the prevalence, severity, and risk factors for liver injury in patients affected by MS treated with pulsed methylprednisolone.…”