Document Detail


Safety issues in the management of autoimmune hepatitis.
MedLine Citation:
PMID:  18462189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prednisone and azathioprine are effective in the treatment of autoimmune hepatitis, but diverse side effects can diminish their net benefit. OBJECTIVES: Describe the frequency and nature of these side effects and propose management strategies to minimize their impact. METHODS: Pertinent articles published from 1970 to 2007 were identified by Medline search and through a personal library. RESULTS: Medication is prematurely discontinued in 13% of patients mainly because of cosmetic changes, cytopenia, or osteopenia. Populations at high risk are the elderly, those with pre-existent co-morbidities, patients with near-zero thiopurine methyltransferase activity, individuals who are treatment-dependent, pregnant women, and asymptomatic patients who are over-treated. CONCLUSIONS: Proper patient selection, effective pre-treatment counseling, preemptive protective measures, realistic treatment objectives, and early identification of problematic patients can reduce complications. Individualized dosing schedules and the emergence of non-steroidal medications are realistic expectations.
Authors:
Albert J Czaja
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on drug safety     Volume:  7     ISSN:  1744-764X     ISO Abbreviation:  Expert Opin Drug Saf     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-06-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101163027     Medline TA:  Expert Opin Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  319-33     Citation Subset:  IM    
Affiliation:
Mayo Clinic and Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA. czaja.albert@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Azathioprine* / administration & dosage,  adverse effects,  therapeutic use
Drug Therapy, Combination
Glucocorticoids* / administration & dosage,  adverse effects,  therapeutic use
Hepatitis, Autoimmune / drug therapy*
Humans
Immunosuppressive Agents* / administration & dosage,  therapeutic use
Patient Selection
Prednisone* / administration & dosage,  adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Immunosuppressive Agents; 446-86-6/Azathioprine; 53-03-2/Prednisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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