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Digestion. 2011;84(1):54-9. doi: 10.1159/000322298. Epub 2011 Feb 8.

Steroid and ursodesoxycholic Acid combination therapy in severe drug-induced liver injury.

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1
Department of Gastroenterolgy and Hepatology, University Hospital Essen, Essen, Germany.

Abstract

BACKGROUND:

Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined.

AIM:

We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients.

PATIENTS, MATERIALS AND METHODS:

15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups.

RESULTS:

Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to <50% of peak values within 2 weeks, and normalized within 4-8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months.

CONCLUSION:

Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.

PMID:
21304237
DOI:
10.1159/000322298
[Indexed for MEDLINE]

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