Clinical features of drug-induced liver injury due to <i>Tripterygium wilfordii</i> preparation and concomitant medications in patients with rheumatoid arthritis

Tingting SHEN; Guangyao LI; Qiong LUO; Meng LI; Xin SUN; Yanyan TAO; Zushan ZHOU; Chenghai LIU

doi:10.3969/j.issn.1001-5256.2022.09.022

Volume 38 Issue 9

Sep. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(9): 2067-2072

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Clinical features of drug-induced liver injury due to Tripterygium wilfordii preparation and concomitant medications in patients with rheumatoid arthritis

DOI: 10.3969/j.issn.1001-5256.2022.09.022

Tingting SHEN¹,
Guangyao LI²,
Qiong LUO¹,
Meng LI¹,
Xin SUN^{1, 3},
Yanyan TAO¹,
Zushan ZHOU^{2
,
,
,},
Chenghai LIU^{1, 3
,
,
,}

1.
Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
2.
Department of Rheumatism, Honghu Hospital of Traditional Chinese Medicine, Honghu, Hubei 433220, China
3.
Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai 201203, China

Research funding:

Three-year Action Plan of Shanghai TCM Development (ZY(2018-2020)-CCCX-5001);

Science and Technology Planning Project of Shanghai Science and Technology Commission (20Z21900100);

Shanghai Key Specialty of Traditional Chinese Clinical Medicine (shslczdzk01201)

More Information

Corresponding author: ZHOU Zushan, zzs4013@163.com(ORCID: 0000-0003-4274-2347); LIU Chenghai, chenghailiu@hotmail.com(ORCID: 0000-0002-2033-0934)
Received Date: 2022-01-27
Accepted Date: 2022-02-28
Published Date: 2022-09-20

Abstract

Abstract

Objective To investigate the clinical features of drug-induced liver injury (DILI) due to Tripterygium wilfordii preparation and concomitant medications in patients with rheumatoid arthritis (RA). Methods A retrospective analysis was performed for the clinical data of 112 RA patients with DILI caused by Tripterygium wilfordii preparations and concomitant medications who were treated in Honghu Hospital of Traditional Chinese Medicine from January 2014 to December 2019, and demographic data and the clinical features of DILI were observed to explore the influence of concomitant medications and underlying diseases on DILI. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups and further comparison between two groups. Results All 112 patients had a mean age of 48.13±14.38 years, and there were 81 female patients (72.32%). The most common underlying disease was nonalcoholic fatty liver disease (NAFLD) in 8 patients (7.14%), and as for concomitant medications, 70 patients (62.50%) were treated with Tripterygium wilfordii preparation combined with non-steroid anti-inflammatory drug (NSAID) or disease-modifying anti-rheumatic drug (DMARD). The main clinical manifestation was joint pain in 110 patients (98.21%). Among the 112 patients, 102 (91.07%) had abnormal results of liver biochemical examinations; 66 patients (58.93%) had an RUCAM score of 6-8 points, and 110 patients (98.21%) had mild (grade 1) liver injury. After liver-protecting treatment (for less than 6 months in all patients), all patients had an improvement in liver function without aggravation or death. The Tripterygium wilfordii preparation+glucocorticoid+NSAID/DMARD group with 22 patients had significant increases in the serum levels of alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) compared with the Tripterygium wilfordii preparation+NSAID/DMARD group with 70 patients (P < 0.05). The 8 patients with NAFLD had a significantly greater increase in serum alanine aminotransferase compared with the 90 patients without underlying diseases (P < 0.05). Conclusion RA patients may develop DILI due to Tripterygium wilfordii preparation and concomitant medications, which is commonly observed in middle-aged women. Joint pain is the main clinical manifestation, and patients tend to have mild liver injury and good prognosis without marked chronicity. More severe liver injury is observed in patients with combined medication of glucocorticoids and NSAID/DMARD or those with the underlying disease of NAFLD.
- Arthritis, Rheumatoid,
- Tripterygium,
- Chemical and Drug Induced Liver Injury

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References

[1]	SHEN T, LIU Y, SHANG J, et al. Incidence and etiology of drug-induced liver injury in Mainland China[J]. Gastroenterology, 2019, 156(8): 2230-2241. e11. DOI: 10.1053/j.gastro.2019.02.002.
[2]	ZHU CW, WANG HN, YUAN JL, et al. Clinical features of drug-induced liver injury: an analysis of 445 cases[J]. J Clin Hepatol, 2018, 34(2): 5. DOI: 10.3969/j.issn.1001-5256.2018.02.027. 朱春雾, 王海南, 袁继丽, 等. 445例药物性肝损伤的临床分析[J]. 临床肝胆病杂志, 2018, 34(2): 5. DOI: 10.3969/j.issn.1001-5256.2018.02.027.
[3]	XU JM. A multicenter survey on hospital inpatients with drug-induced acute liver injury in China[J]. Chin J Dig, 2007, 27(7): 439-442. DOI: 10.3760/j.issn:0254-1432.2007.07.003. 许建明. 全国多中心急性药物性肝损伤住院病例调研分析[J]. 中华消化杂志, 2007, 27(7): 439-442. DOI: 10.3760/j.issn:0254-1432.2007.07.003.
[4]	ZHU Y, NIU M, CHEN J, et al. Hepatobiliary and pancreatic: Comparison between Chinese herbal medicine and Western medicine-induced liver injury of 1985 patients[J]. J Gastroenterol Hepatol, 2016, 31(8): 1476-1482. DOI: 10.1111/jgh.13323.
[5]	ZHOU Y, YANG L, LIAO Z, et al. Epidemiology of drug-induced liver injury in China: a systematic analysis of the Chinese literature including 21, 789 patients[J]. Eur J Gastroenterol Hepatol, 2013, 25(7): 825-829. DOI: 10.1097/MEG.0b013e32835f6889.
[6]	LUO JL, WEI RN, YU TY, et al. Study on the clinical application and dosage of Tripterygium wilfordii[J]. J Changchun Univ Chin Med, 2022, 38(5): 491-494. DOI: 10.13463/j.cnki.cczyy.2022.05.006. 罗金丽, 卫若楠, 于同月, 等. 雷公藤的临床应用及其用量探究[J]. 长春中医药大学学报, 2022, 38(5): 491-494. DOI: 10.13463/j.cnki.cczyy.2022.05.006.
[7]	LIU J, YAN LJ. Effects of triptolide on angiogenesis and PTEN/PI3K/AKT pathway in model rats with rheumatoid arthritis[J]. J Jilin Univ: Med Edit, 2020, 286(6): 1227-1233, 1351. DOI: 10.13481/j.1671-587x.20200619. 刘静, 燕丽君. 雷公藤内酯醇对类风湿性关节炎模型大鼠血管新生和PTEN/PI3K/AKT通路的影响[J]. 吉林大学学报: 医学版, 2020, 286(6): 1227-1233, 1351. DOI: 10.13481/j.1671-587x.20200619.
[8]	ZHU CW, WANG HN, ZHANG YL, et al. Analysis of clinical characteristics in 140 patients with herb-induced liver injury[J]. Chin Hepatol, 2019, 24(4): 362-364. DOI: 10.3969/j.issn.1008-1704.2019.04.009. 朱春雾, 王海南, 张亚蕾, 等. 140例中药肝损伤病例的临床特征分析[J]. 肝脏, 2019, 24(4): 362-364. DOI: 10.3969/j.issn.1008-1704.2019.04.009.
[9]	SONG D, GE FL, ZHANG L, et al. Analysis of liver injury associated with preparations containing tripterygium wilfordii[J]. Chin J Pharmacov, 2019, 16(5): 265-269. DOI: 10.3969/j.issn.1672-8629.2019.05.003. 宋迪, 葛斐林, 张乐, 等. 雷公藤制剂相关肝损伤分析[J]. 中国药物警戒, 2019, 16(5): 265-269. DOI: 10.3969/j.issn.1672-8629.2019.05.003.
[10]	YANG T, ZHANG YL, ZHU TT, et al. A preliminary study on clinical characteristics and toxicology mechanism of tripterygium wilfordii induced liver injury[J]. World Sci Technol Modern Tradit Chin Med, 2018, 20(11): 2027-2032. DOI: 10.11842/wst.2018.11.021. 杨涛, 张亚蕾, 朱亭亭, 等. 雷公藤致肝损伤的临床特点与主要机制[J]. 世界科学技术-中医药现代化, 2018, 20(11): 2027-2032. DOI: 10.11842/wst.2018.11.021.
[11]	Drug - induced Liver Disease Study Group. Chinese guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002. 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002.
[12]	TODOROVIĆVUKOTIĆ N, ƉOR ƉEVIĆ J, et al. Antidepressants- and antipsychotics-induced hepatotoxicity[J]. Arch Toxicol, 2021, 95(3): 767-789. DOI: 10.1007/s00204-020-02963-4.
[13]	BENESIC A, JALAL K, GERBES AL. Drug-drug combinations can enhance toxicity as shown by monocyte-derived hepatocyte-like cells from patients with idiosyncratic drug-induced liver injury[J]. Toxicol Sci, 2019. DOI: 10.1093/toxsci/kfz156.[Online ahead of print]
[14]	MARTINEZ MA, VUPPALANCHI R, FONTANA RJ, et al. Clinical and histologic features of azithromycin-induced liver injury[J]. Clin Gastroenterol Hepatol, 2015, 13(2): 369-376. e3. DOI: 10.1016/j.cgh.2014.07.054.
[15]	DEVARBHAVI H, AITHAL G, TREEPRASERTSUK S, et al. Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines[J]. Hepatol Int, 2021, 15(2): 258-282. DOI: 10.1007/s12072-021-10144-3.
[16]	CHALASANI N, BONKOVSKY HL, FONTANA R, et al. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN prospective study[J]. Gastroenterology, 2015, 148(7): 1340-1352. e7. DOI: 10.1053/j.gastro.2015.03.006.
[17]	CHALASANI NP, HAYASHI PH, BONKOVSKY HL, et al. ACG clinical guideline: the diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol, 2014, 109(7): 950-966; quiz 967. DOI: 10.1038/ajg.2014.131.
[18]	FROMENTY B. Drug-induced liver injury in obesity[J]. J Hepatol, 2013, 58(4): 824-826. DOI: 10.1016/j.jhep.2012.12.018.
[19]	MICHAUT A, MOREAU C, ROBIN MA, et al. Acetaminophen-induced liver injury in obesity and nonalcoholic fatty liver disease[J]. Liver Int, 2014, 34(7): e171-e179. DOI: 10.1111/liv.12514.

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Clinical features of drug-induced liver injury due to Tripterygium wilfordii preparation and concomitant medications in patients with rheumatoid arthritis

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Clinical features of drug-induced liver injury due to Tripterygium wilfordii preparation and concomitant medications in patients with rheumatoid arthritis

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