Open AccessLiver injury after pulsed methylprednisolone therapy in multiple sclerosis patients
Author(s) -
Nociti Viviana,
Biolato Marco,
De Fino Chiara,
Bianco Assunta,
Losavio Francesco Antonio,
Lucchini Matteo,
Marrone Giuseppe,
Grieco Antonio,
Mirabella Massimiliano
Publication year - 2018
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.968
Subject(s) - methylprednisolone , medicine , liver injury , prospective cohort study , gastroenterology , multiple sclerosis , observational study , surgery , immunology
Objectives High‐dose pulsed methylprednisolone‐related liver injury cases have been reported in the literature, but a prospective study in patients with multiple sclerosis (MS) has never been performed. The aim of this study was to evaluate the prevalence and severity of liver injury in patients with MS after pulsed methylprednisolone therapy. Methods We performed a prospective observational single‐center study on patients with MS treated with i.v. methylprednisolone 1,000 mg/day for 5 days. We tested the liver functionality before and 2 weeks after the treatment. In case of severe liver injury, defined according to “Hy's law,” a comprehensive hepatologic workup was performed. Results During a 12‐month observation period, we collected data on 251 cycles of i.v. steroid treatment of 175 patients with MS. After excluding eight cycles presenting a basal alteration of the biochemical liver tests, we observed a prevalence of 8.6% of liver injury in MS patients treated with pulsed methylprednisolone for clinical and neuroradiological relapses. In 2.5% of the patients, the liver injury was severe according to Hy's law; after a comprehensive hepatologic workup, three of them received a diagnosis of drug‐induced liver injury and the other three of autoimmune hepatitis. Conclusions Liver injury after pulsed methylprednisolone therapy in patients with MS is not infrequent, and a close monitoring of aminotransferase level before treatment and 2 weeks later seems advisable.