YAKHAK HOEJI (약학회지)

The Pharmaceutical Society of Korea (대한약학회)
권호 표지

Prediction of the Hepatotoxicity Risk Factor Induced by Antituberculosis Agents in Koreans

한국인의 항결핵제에 의한 간독성 위험인자 예측

  • Lee, Ji-Sun (Clinical Pharmacy, College of Pharmacy, Chungbuk National University) ;
  • Kim, Hyun-Ah (Clinical Pharmacy, College of Pharmacy, Seoul National University) ;
  • Cho, Eun (Graduate School of Public Health, Yonsei University Health System) ;
  • Lee, Ok-Sang (Clinical Pharmacy, College of Pharmacy, Chungbuk National University) ;
  • Lim, Sung-Cil (Clinical Pharmacy, College of Pharmacy, Seoul National University)
  • Received : 2011.07.13
  • Accepted : 2011.07.29
  • Published : 2011.08.31
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Abstract

Standard combination chemotherapy including isoniazid, rifampin, pyrazinamide, and ethambutol is very effective against tuberculosis. But, these medicines can cause hepatotoxicity which is the main reason for treatment interruption or change in drug regimen. In order to identify risk factors associated with hepatotoxcity in Koreans and assess elevated baseline LFTs' contributions to hepatotoxicity, a retrospective case control study was performed. The medical records of 277 patients who diagnosed with tuberculosis at a community hospital from January 1st, 2007 to June 30th, 2010 were reviewed. Patients were categorized into 3 groups (non toxic group, patients without increase in LFT levels; mild to moderate hepatotoxic group and severe hepatotoxic group). And the correlation between risk factors and hepatotoxicity was analyzed by using SPSS program. The overall incidence of hepatotoxicity was 18% and 8.7% of patients developed severe toxicity. Patients in the severe toxic group had the longest treatment period among the three groups. In 75% of severe toxic group, hepatotoxicity occurred within 18.3 days after starting medication. Hypoalbuminemia (serum albumin <3 g/dl) was a significant risk factor for development of severe toxicity. Elevated baseline transaminase (except ALT), total bilirubin, and preexisting hepatitis were also risk factors which were more than twice as likely to increase risk of severe hepatotoxicity (p>0.05). In conclusion, hypoalbuminemia (serum albumin level <3 g/dl) was a significant risk factor for anti-tuberculosis druginduced severe toxicity. Therefore, before starting antituberculosis chemotherapy, serum albumin level should be assessed at baseline. In high-risk patients (hypoalbuminemia, elevated LFTs) for hepatotoxicty, liver function should be closely monitored up to at least 21 days after taking medication.

Keywords

References

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