Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy
Purpose. Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment in active moderate-to-severe Graves’ orbitopathy (GO) and dysthyroid optic neuropathy (DON). One of the adverse effects of this therapy is liver dysfunction that can be mild (ALT < 100 U/L), moderate (ALT: 10...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2018/1978590 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832562038260367360 |
|---|---|
| author | Piotr Miśkiewicz Anna Jankowska Kinga Brodzińska Justyna Milczarek-Banach Urszula Ambroziak |
| author_facet | Piotr Miśkiewicz Anna Jankowska Kinga Brodzińska Justyna Milczarek-Banach Urszula Ambroziak |
| author_sort | Piotr Miśkiewicz |
| collection | DOAJ |
| description | Purpose. Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment in active moderate-to-severe Graves’ orbitopathy (GO) and dysthyroid optic neuropathy (DON). One of the adverse effects of this therapy is liver dysfunction that can be mild (ALT < 100 U/L), moderate (ALT: 100–300 U/L), and severe defined as acute liver injury (ALI) (ALT > 300 U/L). ALI can be irreversible and fatal. The aim of the study was to evaluate the influence of two different schemes of therapy with IVMP in moderate-to-severe GO and DON on biochemical liver parameters. Materials and Methods. 49 patients with moderate-to-severe GO were treated with IVMP in every week schedule (cumulative dose 4.5 g), and 19 patients with DON received 3.0 g IVMP (1.0 g/day for 3 consecutive days). AST, ALT, and total bilirubin were measured before treatment and after IVMP in the following selected pulses: after 0.5 g (A1), 3.0 g (A2), and 4.5 g (A3) in the group with moderate-to-severe GO and after 3.0 g IVMP in the group with DON (B1). Results. We observed a statistically higher level of AST and ALT after therapy with 3.0 g of IVMP (B1) than after 0.5 g (A1), 3.0 g (A2), and 4.5 g of IVMP (A3). Mild elevation of ALT was found in 4% and 11% of patients with moderate-to-severe GO and DON, respectively. Moderate elevation of ALT was found in 0% and 21% of patients with moderate-to-severe GO and DON, respectively. There were no cases of ALI. Conclusion. Therapy of GO with higher doses (1.0 g) of IVMP in consecutive days is associated with higher risk of liver damage than treatment with moderate doses (≤0.5 g) in every week schedule. This trial is registered with NCT03667157. |
| format | Article |
| id | doaj-art-2e92fb41ae874ebeaabb48a77473a192 |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Endocrinology |
| spelling | doaj-art-2e92fb41ae874ebeaabb48a77473a1922025-02-03T01:23:29ZengWileyInternational Journal of Endocrinology1687-83371687-83452018-01-01201810.1155/2018/19785901978590Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ OrbitopathyPiotr Miśkiewicz0Anna Jankowska1Kinga Brodzińska2Justyna Milczarek-Banach3Urszula Ambroziak4Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, PolandDepartment of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, PolandDepartment of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, PolandDepartment of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, PolandDepartment of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, PolandPurpose. Intravenous methylprednisolone (IVMP) pulse therapy is the first-line treatment in active moderate-to-severe Graves’ orbitopathy (GO) and dysthyroid optic neuropathy (DON). One of the adverse effects of this therapy is liver dysfunction that can be mild (ALT < 100 U/L), moderate (ALT: 100–300 U/L), and severe defined as acute liver injury (ALI) (ALT > 300 U/L). ALI can be irreversible and fatal. The aim of the study was to evaluate the influence of two different schemes of therapy with IVMP in moderate-to-severe GO and DON on biochemical liver parameters. Materials and Methods. 49 patients with moderate-to-severe GO were treated with IVMP in every week schedule (cumulative dose 4.5 g), and 19 patients with DON received 3.0 g IVMP (1.0 g/day for 3 consecutive days). AST, ALT, and total bilirubin were measured before treatment and after IVMP in the following selected pulses: after 0.5 g (A1), 3.0 g (A2), and 4.5 g (A3) in the group with moderate-to-severe GO and after 3.0 g IVMP in the group with DON (B1). Results. We observed a statistically higher level of AST and ALT after therapy with 3.0 g of IVMP (B1) than after 0.5 g (A1), 3.0 g (A2), and 4.5 g of IVMP (A3). Mild elevation of ALT was found in 4% and 11% of patients with moderate-to-severe GO and DON, respectively. Moderate elevation of ALT was found in 0% and 21% of patients with moderate-to-severe GO and DON, respectively. There were no cases of ALI. Conclusion. Therapy of GO with higher doses (1.0 g) of IVMP in consecutive days is associated with higher risk of liver damage than treatment with moderate doses (≤0.5 g) in every week schedule. This trial is registered with NCT03667157.http://dx.doi.org/10.1155/2018/1978590 |
| spellingShingle | Piotr Miśkiewicz Anna Jankowska Kinga Brodzińska Justyna Milczarek-Banach Urszula Ambroziak Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy International Journal of Endocrinology |
| title | Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy |
| title_full | Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy |
| title_fullStr | Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy |
| title_full_unstemmed | Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy |
| title_short | Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy |
| title_sort | influence of methylprednisolone pulse therapy on liver function in patients with graves orbitopathy |
| url | http://dx.doi.org/10.1155/2018/1978590 |
| work_keys_str_mv | AT piotrmiskiewicz influenceofmethylprednisolonepulsetherapyonliverfunctioninpatientswithgravesorbitopathy AT annajankowska influenceofmethylprednisolonepulsetherapyonliverfunctioninpatientswithgravesorbitopathy AT kingabrodzinska influenceofmethylprednisolonepulsetherapyonliverfunctioninpatientswithgravesorbitopathy AT justynamilczarekbanach influenceofmethylprednisolonepulsetherapyonliverfunctioninpatientswithgravesorbitopathy AT urszulaambroziak influenceofmethylprednisolonepulsetherapyonliverfunctioninpatientswithgravesorbitopathy |