Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

Abstract

ObjectivesHigh‐dose pulsed methylprednisolone‐related liver injury cases have been reported in the literature, but a prospective study in patients with multiple sclerosis (MS) has never been performed. The aim of this study was to evaluate the prevalence and severity of liver injury in patients with MS after pulsed methylprednisolone therapy.MethodsWe performed a prospective observational single‐center study on patients with MS treated with i.v. methylprednisolone 1,000 mg/day for 5 days. We tested the liver functionality before and 2 weeks after the treatment. In case of severe liver injury, defined according to “Hy's law,” a comprehensive hepatologic workup was performed.ResultsDuring a 12‐month observation period, we collected data on 251 cycles of i.v. steroid treatment of 175 patients with MS. After excluding eight cycles presenting a basal alteration of the biochemical liver tests, we observed a prevalence of 8.6% of liver injury in MS patients treated with pulsed methylprednisolone for clinical and neuroradiological relapses. In 2.5% of the patients, the liver injury was severe according to Hy's law; after a comprehensive hepatologic workup, three of them received a diagnosis of drug‐induced liver injury and the other three of autoimmune hepatitis.ConclusionsLiver injury after pulsed methylprednisolone therapy in patients with MS is not infrequent, and a close monitoring of aminotransferase level before treatment and 2 weeks later seems advisable.

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.…”

“…Nociti et al 23 performed a prospective observational study on patients with MS after methylprednisolone therapy and observed a prevalence of 8.6% of liver injury. They described six cases of patients with severe liver injury after pulsed methylprednisolone therapy; five of them were female and three of them with a probable autoimmune hepatitis.…”

“…Liver injury caused by corticosteroids varied from asymptomatic hypertransaminasaemia to fulminant hepatic failure 10–24. Acute presentations include mild liver test abnormalities, cholestasis with pruritus, and sometimes acute liver failure mimicking aggressive conditions such as viral hepatitis.…”

“…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.…”

<p>Vitamin D supplementation for the prevention or depletion of side effects of therapy with alemtuzumab in multiple sclerosis</p>

“…In terms of differential diagnosis, AIH must be distinguished from a drug-induced liver injury caused by AI, which can be confirmed by re-exposure 83. As a supplement, liver injury after pulsed methylprednisolone therapy in PwMS with RRMS has been observed both as acute drug-induced liver injury and as AIH 84,85. AIH was observed in 40 reported cases in PwMS receiving disease-modifying drug therapy 86.…”