Risk of liver injury after α-glucosidase inhibitor therapy in advanced chronic kidney disease patients

Ch, Kao; Wu, Pei Chen; Wu, Che Hsiung; Chen, Li Kwang; Chen, Hsi Hsien; Wu, Mai Szu; Wu, Vin Cent

doi:10.1038/srep18996

Cited by 11 publications

(7 citation statements)

References 41 publications

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“…The incidence of liver injury in this study was comparable to those in the literature (Chen et al, 2014 ). A prior study tested the relationship between acarbose use and the incidence of liver injury among diabetic patients with severe CKD using a more simplistic approach (Kao et al, 2016 ). They compared diabetic acarbose users vs. non-users with severe CKD only, without those carrying ESRD, enrolled fewer cases in their study, and did not adjust for other hepatotoxic medications or account for background hepatic diseases explicitly (Kao et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…A prior study tested the relationship between acarbose use and the incidence of liver injury among diabetic patients with severe CKD using a more simplistic approach (Kao et al, 2016 ). They compared diabetic acarbose users vs. non-users with severe CKD only, without those carrying ESRD, enrolled fewer cases in their study, and did not adjust for other hepatotoxic medications or account for background hepatic diseases explicitly (Kao et al, 2016 ). Our findings further strengthen their conclusions by showing that acarbose can be used safely in diabetic CKD/ESRD patients regardless of the presence or absence of CLD.…”

Section: Discussionmentioning

confidence: 99%

“…We defined the case as the presence of any of the following diagnosis based on the literature: bilirubin excretion disorders (277.4), toxic hepatitis (573.3), other specified or unspecified hepatic disorder (573.8, 573.9), acute/subacute hepatic necrosis (570), other biliary tract disorders (576.8), and non-neonatal unspecified jaundice (782.4), using code combinations deriving from prior reports (Kao et al, 2014 ; Chang et al, 2015 ). Based on the existing reports of acarbose-related liver injury (Kao et al, 2016 ), assuming that the incidence of any liver injury event in the control during follow-up was 2–3%, with a significance level of 0.05 and a power of 0.8, at least 1,859 patients would be needed per group.…”

Section: Methodsmentioning

confidence: 99%

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Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

2018

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Background: Acarbose has been deemed contraindicated in diabetic patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), but such use is not uncommon. We tested whether this concept hold true in this population with different background hepatic diseases.Methods: All incident diabetic patients (n = 2,036,531) with stage 5 CKD/ESRD were enrolled from Taiwan between 2017 and 2013 and divided into those without chronic liver disease (CLD), with CLD but without cirrhosis, and those with cirrhosis. Among each group, acarbose users, defined as cumulative use >30 days within the preceding year, were propensity-score matched 1:2 to non-users. Our main outcome was the development of liver injury events during follow-up.Results: Acarbose users did not exhibit an increased incidence of liver injury during follow-up compared to non-users (hazard ratio and 95% confidence interval, 1.04 [0.88–1.25], 0.97 [0.61–1.56], and 0.71 [0.33–1.54] among those without CLD, with CLD but without cirrhosis, and those with cirrhosis, respectively), after adjusting for demographic profiles, comorbidities, potentially hepatotoxic medication use, and diabetic severity.Conclusions: The incidence of liver injury did not increase significantly among diabetic acarbose users with severe renal insufficiency than non-users, regardless of the presence or absence of chronic liver disease. Our findings support the renaissance of acarbose as a useful adjunct in diabetic patients with stage 5 and 5D chronic kidney disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

2018

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“…The common side effects of AGIs are flatulence, gut discomfort, diarrhoea, and bloating. Hepatic injury is a rare side effect reported with AGIs use [82].…”

Section: Alpha-glucosidase Inhibitors (Agis)mentioning

confidence: 99%

Systematic Review on Medicaments Used in Management of Diabetes Mellitus

Jamwal¹

2020

Int J Pharm Pharm Sci

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Diabetes has a global prevalence in developed countries and rapidly flexing its roots in middle-and low-income countries. According to the World Health Organization, it is a major cause of kidney collapse, heart problems, and lower limb amputation. Diabetes mellitus is a metabolic disorder showing an uncontrolled increase in blood glucose levels. To date, no permanent cure has been developed for the complete restoration of impaired glucose haemostasis. With the use of therapeutic agents and nontherapeutic agents, glucose levels can be kept in control for a very long time. The foremost goal of all current ongoing treatments is to control high blood glucose levels, reduction in elevated lipid levels, and delay in the progression of diabetes-related complications. Various therapeutics agents are developed in recent decades, which shown very promising results in the management of diabetes mellitus. These agents prescribed after reviewing the clinical symptoms and situation of an individual patient. This review compiles noteworthy information related to clinically approved medicaments for diabetes mellitus. Review emphasis on categorization, mechanism of action, noted adverse effects along with the physiological responses of used medicines to treat diabetes mellitus.

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“…For diabetic patients, α-glucosidase inhibitors (AGIs) are widely applied either as monotherapy or in combination with other oral hypoglycemic agents or insulin (Hung et al, 2012 ). However, AGIs-induced serious liver injuries and gastrointestinal side effects restricted the clinical practice (Yin et al, 2014 ; Kao et al, 2016 ). In view of the limited number of safe anti-diabetic drugs with low toxicity and ever-increasing number of diabetic patients, the exploration for new α-glucosidase inhibitors, attracted, and still attract great interests from scientific community.…”

Section: Introductionmentioning

confidence: 99%

α-Glucosidase Inhibitors From the Coral-Associated Fungus Aspergillus terreus

Liu

Sun

et al. 2018

Front. Chem.

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Nine novel butenolide derivatives, including four pairs of enantiomers, named (±)-asperteretones A–D (1a/1b–4a/4b), and a racemate, named asperteretone E (5), were isolated and identified from the coral-associated fungus Aspergillus terreus. All the structures were established based on extensive spectroscopic analyses, including HRESIMS and NMR data. The chiral chromatography analyses allowed the separation of (±)-asperteretones A–D, whose absolute configurations were further confirmed by experimental and calculated electronic circular dichroism (ECD) analysis. Structurally, compounds 2–5 represented the first examples of prenylated γ-butenolides bearing 2-phenyl-3-benzyl-4H-furan-1-one motifs, and their crucial biogenetically related metabolite, compound 1, was uniquely defined by an unexpected cleavage of oxygen bridge between C-1 and C-4. Importantly, (±)-asperteretal D and (4S)-4-decarboxylflavipesolide C were revised to (±)-asperteretones B (2a/2b) and D (4), respectively. Additionally, compounds 1a/1b–4a/4b and 5 were evaluated for the α-glucosidase inhibitory activity, and all these compounds exhibited potent inhibitory potency against α-glucosidase, with IC50 values ranging from 15.7 ± 1.1 to 53.1 ± 1.4 μM, which was much lower than that of the positive control acarbose (IC50 = 154.7 ± 8.1 μM), endowing them as promising leading molecules for the discovery of new α-glucosidase inhibitors for type-2 diabetes mellitus treatment.

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Risk of liver injury after α-glucosidase inhibitor therapy in advanced chronic kidney disease patients

Cited by 11 publications

References 41 publications

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

Acarbose Use and Liver Injury in Diabetic Patients With Severe Renal Insufficiency and Hepatic Diseases: A Propensity Score-Matched Cohort Study

Systematic Review on Medicaments Used in Management of Diabetes Mellitus

α-Glucosidase Inhibitors From the Coral-Associated Fungus Aspergillus terreus

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