Contributions
Abstract: P1175
Type: Poster
Abstract Category: Therapy - disease modifying - Immunomodulation/Immunosuppression
Background and aims: Few isolated cases of methylprednisolone (MP)-induced hepatitis in patients with multiple sclerosis (MS) are reported in literature but a systematic investigation had never been performed. The aim of the study is to evaluate the prevalence of liver injury and hepatitis in patients affected by MS and treated with intravenous (i.v.) MP because of clinical relapses.
Patients and methods: During 12 month observation period, we collected 249 cycles of i.v. high dose steroid treatment from 175 patients (65% females, mean age of 40.8 ± 12.2 years; mean Expanded disability status scale (EDSS) pre-relapse of 2.74 ± 2.11, mean EDSS post-relapse 3.22 ± 1.91). All patients, in relapsing phase of the disease, were treated with i.v. MP (1000 mg/day for 5 days). We tested liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total and direct bilirubin, γ-glutamyl transpeptidase) before treatment and after two weeks. In case of increased enzymes levels, a new laboratory test was made after two weeks, until the normalization of liver function. In case of persistent increasing in liver enzymes a systemic search of principal causes of acute hepatitis was performed (microbiological and immunological screening, a liver ultrasounds and in some selected cases a liver biopsy) and specific therapy was started.
Results: Twenty-six patients (15%) developed a liver damage, documented by an increase in liver enzyme (particularly ALT) tested two weeks after steroid therapy. Six of them presented a severe hepatocellular injury according to Hy"s law: three subsequently were diagnosed as probable methylprednisolone-induced liver injury, while in the other three an autoimmune hepatitis was diagnosed and a treatment with budesonide and azathioprine was started.
Conclusions: This study highlights the importance of close follow-up of liver function following the i.v. administration of MP. Although in most cases the increase in liver enzymes was mild and the recovery was spontaneous and occurred about in a month, some patients developed a major liver disease which need hepatologic work-up. According to our experience, it is advisable to test liver function two weeks after steroid"s pulse. While increased, liver tests have to be repeated every two weeks until normalization, otherwise a liver biopsy is recommended to evaluate severity of liver injury and possible alternative diagnosis.
Nociti and De Fino equally contributed to this work
Disclosure: Nociti V: has received honoraria for scientific advisory boards for Novartis, Teva, Biogen Idec, Sanofi-Aventis Genzyme, and Bayer Schering, has received funding for travel and speaker honoraria from Teva, Biogen Idec, Bayer Schering, Merck Serono, Almirall, Genzyme and Novartis, and receives research support from Almirall.
Biolato M: nothing to discolse
De Fino C: nothing to discolse
Bianco A: nothing to discolse
Losavio F: nothing to discolse
Lucchini M: nothing to discolse
Grieco A: nothing to discolse
Mirabella M: has received honoraria for scientific lectures and advisory board activities from Biogen Novartis, Teva, Sanofi Genzyme, Bayer Shering, Merck Serono, Almirall and research support from Merck Serono, Novartis, Teva, GenzymeAll the other authors have no actual or potential conflict of interest to disclose regarding this work.
Abstract: P1175
Type: Poster
Abstract Category: Therapy - disease modifying - Immunomodulation/Immunosuppression
Background and aims: Few isolated cases of methylprednisolone (MP)-induced hepatitis in patients with multiple sclerosis (MS) are reported in literature but a systematic investigation had never been performed. The aim of the study is to evaluate the prevalence of liver injury and hepatitis in patients affected by MS and treated with intravenous (i.v.) MP because of clinical relapses.
Patients and methods: During 12 month observation period, we collected 249 cycles of i.v. high dose steroid treatment from 175 patients (65% females, mean age of 40.8 ± 12.2 years; mean Expanded disability status scale (EDSS) pre-relapse of 2.74 ± 2.11, mean EDSS post-relapse 3.22 ± 1.91). All patients, in relapsing phase of the disease, were treated with i.v. MP (1000 mg/day for 5 days). We tested liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total and direct bilirubin, γ-glutamyl transpeptidase) before treatment and after two weeks. In case of increased enzymes levels, a new laboratory test was made after two weeks, until the normalization of liver function. In case of persistent increasing in liver enzymes a systemic search of principal causes of acute hepatitis was performed (microbiological and immunological screening, a liver ultrasounds and in some selected cases a liver biopsy) and specific therapy was started.
Results: Twenty-six patients (15%) developed a liver damage, documented by an increase in liver enzyme (particularly ALT) tested two weeks after steroid therapy. Six of them presented a severe hepatocellular injury according to Hy"s law: three subsequently were diagnosed as probable methylprednisolone-induced liver injury, while in the other three an autoimmune hepatitis was diagnosed and a treatment with budesonide and azathioprine was started.
Conclusions: This study highlights the importance of close follow-up of liver function following the i.v. administration of MP. Although in most cases the increase in liver enzymes was mild and the recovery was spontaneous and occurred about in a month, some patients developed a major liver disease which need hepatologic work-up. According to our experience, it is advisable to test liver function two weeks after steroid"s pulse. While increased, liver tests have to be repeated every two weeks until normalization, otherwise a liver biopsy is recommended to evaluate severity of liver injury and possible alternative diagnosis.
Nociti and De Fino equally contributed to this work
Disclosure: Nociti V: has received honoraria for scientific advisory boards for Novartis, Teva, Biogen Idec, Sanofi-Aventis Genzyme, and Bayer Schering, has received funding for travel and speaker honoraria from Teva, Biogen Idec, Bayer Schering, Merck Serono, Almirall, Genzyme and Novartis, and receives research support from Almirall.
Biolato M: nothing to discolse
De Fino C: nothing to discolse
Bianco A: nothing to discolse
Losavio F: nothing to discolse
Lucchini M: nothing to discolse
Grieco A: nothing to discolse
Mirabella M: has received honoraria for scientific lectures and advisory board activities from Biogen Novartis, Teva, Sanofi Genzyme, Bayer Shering, Merck Serono, Almirall and research support from Merck Serono, Novartis, Teva, GenzymeAll the other authors have no actual or potential conflict of interest to disclose regarding this work.