Acute severe hepatitis with alemtuzumab and rechallenge after a year
Acute severe hepatitis with alemtuzumab and rechallenge after a year
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DOI：
10.1016/j.jocn.2018.10.055
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发表时间：
2019-02-01
影响因子：
2
通讯作者：
Sood, Siddharth
中科院分区：
文献类型：
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作者：
Beattie, William;Yan, Bernard;Sood, Siddharth
阿仑单抗是一种单克隆抗体，用作复发和缓解多发性硬化症的疾病调节剂。此前并未发现它与药物性肝损伤有关。在此，我们介绍了一名 49 岁女性的病例，该病例发生继发于阿仑单抗的药物性肝损伤，经再次用药后得到证实。我们的患者在开始阿仑单抗治疗后两天内出现严重肝炎，无论是最初还是再次治疗后。在阿仑单抗初始剂量和再次给药后，丙氨酸氨基转移酶分别达到每升 577 单位和 426 单位的峰值。患者的肝功能测试在两次阿仑单抗治疗之间显着改善，并在第二次治疗后三个月内再次恢复正常，没有急性肝衰竭的临床表现。全面的肝炎筛查排除了肝炎的其他原因，包括自身免疫性肝炎和与其他药物相关的肝毒性。故意重新服用被认为与药物性肝损伤有关的药物并不常见，但在适当的临床背景下为因果关系提供了充分的证据。 Roussel Uclaf 因果关系评估方法评分计算为 9，表明阿仑单抗引起药物性肝损伤的可能性很高。药物性肝损伤是一种潜在的严重疾病，在阿仑单抗治疗复发和缓解型多发性硬化症期间应进行监测。应根据具体情况权衡重新挑战的作用。 (C) 2018 Elsevier Ltd. 保留所有权利。
Alemtuzumab is a monoclonal antibody used as a disease modifying agent in relapsing and remitting multiple sclerosis. It has not previously been associated with drug induced liver injury.Here we present a case of a 49 year old female developing drug induced liver injury secondary to alemtuzumab, confirmed upon rechallenge. Our patient developed severe hepatitis within two days of starting alemtuzumab, both initially and upon rechallenge. The alanine aminotransferase peaked at 577 units per litre and 426 units per litre after initial dose of alemtuzumab and rechallenge respectively. The patient's liver function tests improved significantly between doses of alemtuzumab and again normalised within three months of the second dose, with no clinical manifestations of acute hepatic failure. A full hepatitis screen ruled out alternative causes of hepatitis, including autoimmune hepatitis and hepatotoxicity relating to other medications.Deliberate rechallenge with a medication thought to be associated with drug induced liver injury is uncommonly performed but provides substantial evidence for causality in the appropriate clinical context. The Roussel Uclaf Causality Assessment Method score was calculated as nine, indicating that drug induced liver injury due to alemtuzumab is highly probable.Drug induced liver injury is a potentially serious condition that should be monitored for during alemtuzumab treatment of relapsing and remitting multiple sclerosis. The role of a rechallenge should be weighed up on a case by case basis. (C) 2018 Elsevier Ltd. All rights reserved.