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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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