Year: 2005
Type: article
Study design: Case Report
Abstract: ALT) 29 IU/L, lactate dehydrogenase (LDH) 183 IU/L, alkaline phosphatase (ALP) 367 IU/L and gamma-glutamil transpeptidase (γ-GTP) 272 IU/L.Regarding the hepatitis virus, hepatitis B virus surface antigen and hepatitis C virus antibody were both negative.Serology revealed a high level of IgM of 393 mg/dL, and the antinuclear antibody of 80-fold and antimitochondrial antibody (AMA) of 320-fold each and antibody of 176 U/mL were positive for pyruvate dehydrogenase complex-E2.Histopathologically, a damaged bile duct with aggregates of lymphocytes with a nonsuppurative inflammatory destruction of the small bile duct and granuloma was seen in the portal area, which was compatible with those of Scheuer's stage 1 of primary biliary cirrhosis.Based on the diagnosis of primary biliary cirrhosis, the administration of fenofibrate 150 mg per day was initiated in addition to 600 mg of UDCA.A fever of over 37.5 ℃, anorexia and discomfort in the right hypochondrium appeared 11 d after the administration of fenofibrate.Liver injury such as elevations of total bilirubin of 1.8 mg/dL, AST 268, ALT 216, ALP 537, and γ��TP γ��TP -GTP 660 IU/L was confirmed, and both the CRP level and the ratio of eosinophils in the peripheral blood increased to 5.14 mg/dL and 14.4 %, respectively.She was diagnosed to have fenofibrate�induced liver injury based on the laboratory data and the clinical course.Therefore, fenofibrate was discontinued, however, UDCA continued to be administered continuously.Thereafter, the serum concentrations of AST, ALT, ALP, γ��TP, CRP, and the rate of eosino� γ��TP, CRP, and the rate of eosino� -GTP, CRP, and the rate of eosinophils rapidly returned to the pretreatment levels of 30, 27, 457, 399 IU/L, less than 0.3 mg/dL and 4.6 %, respectively, 12 d after the discontinuation of fenofibrate (Figure 1).Later, the lymphocyte stimulation index for fenofibrate for this patient was found to be positive, while showing a stimulation index of 212 % in comparison to normal samples.Several clinical studies on lipoprotein-lowering agents such as simvastatin [3� 3� � and bezafibrate [4-7� 4-7� � on PBC patients who failed to respond to UDCA have so far been conducted, and the results have been found to be of value.In addition, fenofibrate, a member of such fibrate class agents as bezafibrate, has also recently been found to be a likely agent for PBC because of its stronger antiinflammatory effect via PPARα, and its greater ability to reduce the levels of TG and LDL-C than that of bezafibrate.We previously found fenofibrate to effectively treat UDCA-resistant PBC in nine cases without any adverse effect [2� .Regarding the adverse effect of fenofibrate, a Diabetes Arteriosclerosis Intervention Study (DAIS) showed that micronized fenofibrate at 200 mg (equivalent to 300 mg of Fenofibrate-induced liver injury
Author: Kazufumi Dohmen
Institution: Nagasaki Medical Center
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: hybrid
OpenAlex ID: W1573241199