Ursodeoxycholic acid attenuates hepatotoxicity of multidrug treatment of mycobacterial infections: A prospective pilot study

Lang, Susanne M.; Ortmann, Johannes; Rostig, Sven; Schiffl, Helmut

doi:10.4103/ijmy.ijmy_159_18

Cited by 14 publications

(12 citation statements)

References 2 publications

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“…Although many studies have sought risk factors for DIH, no generally accepted effective treatment is available. It is unclear whether hepatotonics improve DIH [26–28]. In this study, 85.0% of DIH patients took hepatotonics, but we could not confirm that these affected the TB clinical outcomes However, DIH increases socioeconomic health costs because of the need for additional medicines, potential adverse effects, and the requirement for admission to treat DIH.…”

Section: Discussionmentioning

confidence: 74%

The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

et al. 2019

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BackgroundThere are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment. We explored the effects of DIH on the clinical course and outcomes of pulmonary TB.MethodsIn this retrospective cohort study, we included patients with culture-proven pulmonary TB treated in a tertiary hospital from 2013 to 2016. DIH was defined as proposed by the official American Thoracic Society statement. We compared the clinical outcomes of DIH and non-DIH patients.ResultsBetween January 1, 2013 and December 31, 2016, a total of 168 TB patients were included, and 20 (11.9%) were diagnosed with DIH. These patients were significantly older, had a higher Charlson Comorbidity Index score, exhibited more chronic liver disease, included more chronic alcoholics, and had a lower body mass index than non-DIH patients. We found no significant differences between DIH and non-DIH patients in the 2-month sputum culture conversion rate, the time to sputum culture conversion, treatment outcomes, or total treatment duration. However, the ratio of treatment interruption time to total treatment duration and the proportion of hepatotonic users were significantly higher among DIH patients.ConclusionDIH development during TB treatment does not significantly affect the clinical outcomes of pulmonary TB. However, treatment interruption caused by DIH may increase the risks of future relapse and acquired resistance. Further study is needed.

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Section: Discussionmentioning

confidence: 74%

The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

et al. 2019

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“…A prospective pilot study investigated the hepatoprotective effectiveness of UDCA to tuberculosis-or non-tuberculosis mycobacterial-infected patients with DILI. The results revealed that all patients treated with UDCA show radiological and clinical improvement with no side effects (Lang et al, 2019). A retrospective study in China showed that UDCA can accelerate the recovery of TBIL, DBIL, Bile acid and GGT in patients with moderate and severe DILI while continuous treatment is required for more than 2 weeks (Sun et al, 2015).…”

Section: Ursodeoxycholic Acidmentioning

confidence: 99%

Pharmacotherapies for Drug-Induced Liver Injury: A Current Literature Review

et al. 2022

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Drug-induced liver injury (DILI) has become a serious public health problem. For the management of DILI, discontinuation of suspicious drug or medicine is the first step, but the treatments including drugs and supporting approaches are needed. Reference to clinical patterns and disease severity grades of DILI, the treatment drugs were considered to summarize into hepatoprotective drugs (N-acetylcysteine and Glutathione, Glycyrrhizin acid preparation, Polyene phosphatidylcholine, Bicyclol, Silymarin), anticholestatic drug (Ursodeoxycholic acid, S-adenosylmethionine, Cholestyramine), immunosuppressants (Glucocorticoids) and specific treatment agents (L-carnitine, Anticoagulants). The current article reviewed the accumulated literature with evidence-based medicine researches for DILI in clinical practice. Also the drawbacks of the clinical studies involved in the article, unmet needs and prospective development for DILI therapy were discussed.

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“…These patients in comparison with historical controls from the Drug-Induced Liver Injury Network (DILIN) were found to have a significantly more rapid decrease in TBL levels (Wree et al, 2011) (35). Lang et al (2019) evaluated the utility of UDCA in patients with tuberculosis (TBC) and DILI [defined as an increase in alanine aminotransferase (ALT) > 5 upper limit of normal (ULN), alkaline phosphatase (ALP) > 2 ULN or TBL> 2ULN] due to anti-TBC drugs in a prospective study but uncontrolled design. Thirty-nine out of 285 (9.5%) patients receiving anti-TBC drugs developed clinically relevant hepatotoxicity.…”

Section: Clinical Studies With Ursodeoxycholic Acid In the Drug-induced Liver Injury Treatment Or Preventionmentioning

confidence: 99%

Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review

et al. 2021

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Introduction: Treatment is generally not available for drug-induced liver injury (DILI) patients except in some specific circumstances. The management of DILI is based on the withdrawal of the responsible drug and monitoring the patients and only a few patients need to be referred to a transplant center. Some studies on the role of ursodeoxycholic acid (UDCA) in DILI have been published. The aim of this study was to perform a systematic review of the role of UDCA in the treatment and prevention of DILI.Methods: A search was undertaken in PubMed, with the key words ursodeoxycholic acid, drug-induced liver injury and hepatotoxicity following the PRISMA guidelines.Results: A total of 33 publications were identified: 25 case reports and 8 case series. In 18 of the 25 cases reports (22 patients), authors reported improvement of liver injury associated with UDCA therapy whereas 7 case reports did not show clinical or biochemical improvement after UDCA treatment. There were 4 studies evaluating the role of UDCA in the treatment of DILI, three prospective (one being a clinical trial) and one retrospective studies. Three studies observed liver profile improvements associated with UDCA. In addition, four studies evaluated UDCA in the prevention of DILI: one pilot study, two randomized clinical trials (RCT) and one retrospective study. Three of these studies observed a lower percentage of patients with an increase in transaminases in the groups that used UDCA for DILI prevention.Conclusion: According to available data UDCA seems to have some benefits in the treatment and prevention of DILI. However, the design of the published studies does not allow a firm conclusion to be drawn on the efficacy of UDCA in DILI. A well designed RCT to evaluate the role of UDCA in DILI is needed.

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Ursodeoxycholic acid attenuates hepatotoxicity of multidrug treatment of mycobacterial infections: A prospective pilot study

Cited by 14 publications

References 2 publications

The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

Pharmacotherapies for Drug-Induced Liver Injury: A Current Literature Review

Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review

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