Liver Dysfunction Associated with Intravenous Methylprednisolone Pulse Therapy in Patients with Graves’ Orbitopathy

Abstract

Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment for the active phase of moderate to severe Graves' orbitopathy (GO). However, acute and severe liver damage has been reported during and after IVMP therapy. In this retrospective study, we investigated risk factors for liver dysfunction during and after IVMP therapy based on 175 Japanese patients with moderate to severe GO and treated at our center between 2003 and 2011. The results showed that seven patients developed severe liver dysfunction with elevated serum alanine aminotransferase (ALT > 300 U/L). Mild (40–100 U/L) and moderate (100–300 U/L) increases of ALT occurred in 62 patients (35%) and 10 patients (6%), respectively. Liver dysfunction was more frequently observed in males, in patients receiving high-dose methylprednisolone, and patients aged over 50 years. Preexistent viral hepatitis was significantly associated with liver dysfunction (65% in patients positive for hepatitis B core antibody and patients positive for hepatitis C virus antibodies). Our study confirmed the association of liver dysfunction with IVMP during and after treatment. It suggests that, in patients with GO, evaluation of preexisting risk factors—including viral hepatitis—and careful weekly monitoring of liver function during IVMP therapy and monthly thereafter for 12 months are warranted.

Retracted: Efficacy and safety of mycophenolate mofetil in patients with active moderate‐to‐severe Graves’ orbitopathy

“…Adverse events associated with GC include weight gain, gastrointestinal side effects, glucose intolerance, thin skin and/or osteoporosis . The most common severe side effect is hepatotoxicity . Other severe adverse effects included cardiovascular complications .…”

Comprehensive analysis of patients with neuromyelitis optica spectrum disorder (NMOSD) combined with chronic hepatitis B (CHB) infection and seropositive for anti-aquaporin-4 antibody

“…Previously, acute and severe liver damage were reported after IVMP pulse therapy [37]. In addition, the preexisting infection with viral hepatitis, such as HBV, was significantly associated with liver dysfunction [38]. In our study, patients who had detectable serum HBV DNA showed different degrees of liver damage after receiving therapy with high doses of corticosteroids.…”

Hepatotoxicity after high‐dose intravenous methylprednisolone in multiple sclerosis patients

“…To our concern, a limited number of cases of IVMPinduced hepatotoxicity in MS patients have been reported [2,[7][8][9][10]. In patients at risk, there has been proposed a strict monitoring of liver function once a week during pulse therapy, and once a month for the subsequent 12 months [4]. Considering our cases, and the literature review, we propose an additional liver surveillance in…”