Cargando…

Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study

BACKGROUND: The use of rifampicin for cholestatic pruritus is accompanied by concerns over safety, but the availability of real‐world prescribing data is relatively limited. AIM: We sought to describe the rate and characteristics of rifampicin‐induced hepatitis in a mixed aetiology cohort of patient...

Descripción completa

Detalles Bibliográficos
Autores principales: Webb, G. J., Rahman, S. R., Levy, C., Hirschfield, G. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900962/
https://www.ncbi.nlm.nih.gov/pubmed/29468705
http://dx.doi.org/10.1111/apt.14579
_version_ 1783314516711309312
author Webb, G. J.
Rahman, S. R.
Levy, C.
Hirschfield, G. M.
author_facet Webb, G. J.
Rahman, S. R.
Levy, C.
Hirschfield, G. M.
author_sort Webb, G. J.
collection PubMed
description BACKGROUND: The use of rifampicin for cholestatic pruritus is accompanied by concerns over safety, but the availability of real‐world prescribing data is relatively limited. AIM: We sought to describe the rate and characteristics of rifampicin‐induced hepatitis in a mixed aetiology cohort of patients with established liver disease and cholestatic pruritus. METHODS: Retrospective review of records for out‐patients commenced on rifampicin for pruritus 2012‐2016 inclusive. Rifampicin‐induced hepatitis was recorded where alanine aminotransferase activity (ALT) increased to both ≥5 × baseline and ≥5 × upper limit of normal (ULN), or to both ≥3 × baseline and ≥3 × ULN with concurrent elevation in serum bilirubin to ≥2 × baseline and ≥2 × ULN, in addition to a Roussel‐Uclaf Causality Assessment Method score of “probable” or “highly probable” for rifampicin causality. RESULTS: After exclusions, we reviewed 105 patients who took rifampicin for a median of 131 days. Most had primary biliary cholangitis or primary sclerosing cholangitis; 40 (38.1%) were men and median age was 44 years (IQR: 32‐57). 44 (41.9%) patients had baseline serum bilirubin ≥2 × ULN and 28 (26.7%) ALT ≥3 × ULN. 5 (4.8%) developed rifampicin‐induced hepatitis at a median of 70(range 27‐130) days after drug initiation. No individual or laboratory baseline characteristics were significantly associated with subsequent development of hepatitis. All cases of hepatitis recovered after drug cessation, although one patient was hospitalised and received corticosteroids. CONCLUSIONS: Given the efficacy of rifampicin for an important sub‐group of those with cholestatic pruritus, adult patients, including those with jaundice, can be counselled that 95% of prescriptions are safe, and where hepatitis occurs, including at long latency, drug cessation appears effective.
format Online
Article
Text
id pubmed-5900962
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-59009622018-04-23 Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study Webb, G. J. Rahman, S. R. Levy, C. Hirschfield, G. M. Aliment Pharmacol Ther Safety of Rifampicin in Treatment of Cholestatic Pruritus BACKGROUND: The use of rifampicin for cholestatic pruritus is accompanied by concerns over safety, but the availability of real‐world prescribing data is relatively limited. AIM: We sought to describe the rate and characteristics of rifampicin‐induced hepatitis in a mixed aetiology cohort of patients with established liver disease and cholestatic pruritus. METHODS: Retrospective review of records for out‐patients commenced on rifampicin for pruritus 2012‐2016 inclusive. Rifampicin‐induced hepatitis was recorded where alanine aminotransferase activity (ALT) increased to both ≥5 × baseline and ≥5 × upper limit of normal (ULN), or to both ≥3 × baseline and ≥3 × ULN with concurrent elevation in serum bilirubin to ≥2 × baseline and ≥2 × ULN, in addition to a Roussel‐Uclaf Causality Assessment Method score of “probable” or “highly probable” for rifampicin causality. RESULTS: After exclusions, we reviewed 105 patients who took rifampicin for a median of 131 days. Most had primary biliary cholangitis or primary sclerosing cholangitis; 40 (38.1%) were men and median age was 44 years (IQR: 32‐57). 44 (41.9%) patients had baseline serum bilirubin ≥2 × ULN and 28 (26.7%) ALT ≥3 × ULN. 5 (4.8%) developed rifampicin‐induced hepatitis at a median of 70(range 27‐130) days after drug initiation. No individual or laboratory baseline characteristics were significantly associated with subsequent development of hepatitis. All cases of hepatitis recovered after drug cessation, although one patient was hospitalised and received corticosteroids. CONCLUSIONS: Given the efficacy of rifampicin for an important sub‐group of those with cholestatic pruritus, adult patients, including those with jaundice, can be counselled that 95% of prescriptions are safe, and where hepatitis occurs, including at long latency, drug cessation appears effective. John Wiley and Sons Inc. 2018-02-22 2018-04 /pmc/articles/PMC5900962/ /pubmed/29468705 http://dx.doi.org/10.1111/apt.14579 Text en © 2018 The Authors Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Safety of Rifampicin in Treatment of Cholestatic Pruritus
Webb, G. J.
Rahman, S. R.
Levy, C.
Hirschfield, G. M.
Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title_full Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title_fullStr Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title_full_unstemmed Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title_short Low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
title_sort low risk of hepatotoxicity from rifampicin when used for cholestatic pruritus: a cross‐disease cohort study
topic Safety of Rifampicin in Treatment of Cholestatic Pruritus
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900962/
https://www.ncbi.nlm.nih.gov/pubmed/29468705
http://dx.doi.org/10.1111/apt.14579
work_keys_str_mv AT webbgj lowriskofhepatotoxicityfromrifampicinwhenusedforcholestaticpruritusacrossdiseasecohortstudy
AT rahmansr lowriskofhepatotoxicityfromrifampicinwhenusedforcholestaticpruritusacrossdiseasecohortstudy
AT levyc lowriskofhepatotoxicityfromrifampicinwhenusedforcholestaticpruritusacrossdiseasecohortstudy
AT hirschfieldgm lowriskofhepatotoxicityfromrifampicinwhenusedforcholestaticpruritusacrossdiseasecohortstudy