Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

V. Nociti, M. Biolato, C. De Fino, A. Bianco, F.A. Losavio, M. Lucchini, G. Marrone, A. Grieco, M. Mirabella

Research output: Contribution to journalArticle

Abstract

Objectives: High-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. Methods: We 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. Results: During 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. Conclusions: Liver 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. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.
Original languageEnglish
JournalBrain and Behavior
Volume8
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Methylprednisolone
Multiple Sclerosis
Liver
Wounds and Injuries
Therapeutics
Chemical and Drug Induced Liver Injury
Autoimmune Hepatitis
Transaminases
Steroids
Observation
Prospective Studies
Recurrence
Brain

Keywords

  • azathioprine
  • bilirubin
  • budesonide
  • glatiramer
  • glutathione
  • ibuprofen
  • methylprednisolone
  • s adenosylmethionine
  • ursodeoxycholic acid, adult
  • alanine aminotransferase blood level
  • alkaline phosphatase blood level
  • aminotransferase blood level
  • Article
  • autoimmune hepatitis
  • biochemical analysis
  • causality
  • controlled study
  • disease duration
  • disease severity
  • drug megadose
  • dysmenorrhea
  • female
  • human
  • human tissue
  • liver injury
  • major clinical study
  • male
  • middle aged
  • multiple cycle treatment
  • multiple sclerosis
  • observational study
  • Pelizaeus Merzbacher disease
  • polymerase chain reaction
  • priority journal
  • prospective study
  • risk factor
  • young adult

Cite this

Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients. / Nociti, V.; Biolato, M.; De Fino, C.; Bianco, A.; Losavio, F.A.; Lucchini, M.; Marrone, G.; Grieco, A.; Mirabella, M.

In: Brain and Behavior, Vol. 8, No. 6, 2018.

Research output: Contribution to journalArticle

Nociti, V. ; Biolato, M. ; De Fino, C. ; Bianco, A. ; Losavio, F.A. ; Lucchini, M. ; Marrone, G. ; Grieco, A. ; Mirabella, M. / Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients. In: Brain and Behavior. 2018 ; Vol. 8, No. 6.
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abstract = "Objectives: High-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. Methods: We 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. Results: During 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. Conclusions: Liver 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. {\circledC} 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.",
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AU - Nociti, V.

AU - Biolato, M.

AU - De Fino, C.

AU - Bianco, A.

AU - Losavio, F.A.

AU - Lucchini, M.

AU - Marrone, G.

AU - Grieco, A.

AU - Mirabella, M.

N1 - cited By 2

PY - 2018

Y1 - 2018

N2 - Objectives: High-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. Methods: We 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. Results: During 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. Conclusions: Liver 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. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

AB - Objectives: High-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. Methods: We 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. Results: During 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. Conclusions: Liver 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. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

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