Zinc Monotherapy Is Not as Effective as Chelating Agents in Treatment of Wilson Disease

Treatment of Wilson’s disease: our patients deserve better

“…These patients were in hospital, nurses were giving them their medication, and there was no noncompliance. This is the major difference between our work and that of Weiss et al [13] and Gunther et al [14]. In other words, when the patients are known to take their zinc medicine, there are no, zero, nil, nada, zinc failures.…”

“…For example, Weiss et al [13], reporting for two large WD centers in Heidelberg, Germany and Vienna, Austria, reported on 288 patients examined between 1954 and 2008 at these two centers. They titled their paper, "Zinc monotherapy is not as effective as chelating agents in treatment of Wilson's disease".…”

“…We did, and it was zero. Papers by Weiss et al [13], Gunther et al [14], as well as other such papers were obviously written without the realization that in 40 straight WD patients, zinc therapy produced a negative copper balance, and complete blockage of radiocopper uptake [15]. These patients were in hospital, nurses were giving them their medication, and there was no noncompliance.…”

“…In both the Weiss et al [13] and Gunther et al [14] papers, and other papers reporting zinc failures (such as reference [16]), there was no adequate evaluating of compliance, that is, knowledge of whether the patients were actually taking their medicine was inadequate. Zinc is known to have a higher rate of noncompliance than chelators, because it must be taken on an empty stomach, and zinc salts under those conditions cause stomach irritation, severe in about 10%, but bothersome in upward of 30%.…”

“…When you don't monitor your patients for compliance, those who don't comply will have recurrence of their disease and suffer additional damage, potentially irreversible, to liver and/or brain, and may die. These are the bad outcomes Weiss et al [13] reported, more common with zinc than with chelators, all because patients didn't take their zinc. Doctors, if you start patients on a medication that is critical to their survival, you have a responsibility to see that they take it adequately.…”