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Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers

BACKGROUND: Angiotensin type II receptor blockers (ARBs) are the most widely used anti-hypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. METHODS: Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,4...

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Autores principales: Choi, Won Joon, Kim, Gi-Ae, Park, Jaewon, Jang, Sangmi, Jung, Woo Jin, Shim, Jae-Jun, Park, Yewan, Choi, Gwang Hyeon, Kim, Jin-Wook, Jeong, Sook-Hyang, Jang, Eun Sun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9424746/
https://www.ncbi.nlm.nih.gov/pubmed/35996932
http://dx.doi.org/10.3346/jkms.2022.37.e255
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author Choi, Won Joon
Kim, Gi-Ae
Park, Jaewon
Jang, Sangmi
Jung, Woo Jin
Shim, Jae-Jun
Park, Yewan
Choi, Gwang Hyeon
Kim, Jin-Wook
Jeong, Sook-Hyang
Jang, Eun Sun
author_facet Choi, Won Joon
Kim, Gi-Ae
Park, Jaewon
Jang, Sangmi
Jung, Woo Jin
Shim, Jae-Jun
Park, Yewan
Choi, Gwang Hyeon
Kim, Jin-Wook
Jeong, Sook-Hyang
Jang, Eun Sun
author_sort Choi, Won Joon
collection PubMed
description BACKGROUND: Angiotensin type II receptor blockers (ARBs) are the most widely used anti-hypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. METHODS: Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels > 5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM). RESULTS: A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels > 120 IU/L were found in 558 (2.1%) person-years, and levels > 200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation > 120 IU/L per 10(6) cumulative defined daily doses was 6.6, 3.6, 3.9, and 4.0 in the fimasartan, candesartan, valsartan, and losartan groups, respectively (P = 0.002). An ALT level > 200 IU/L with RUCAM score ≥ 6 was found in 20 patients, suggesting probable drug-induced liver injury for 11 (0.2%) patients receiving fimasartan, five (0.1%) receiving candesartan, four (0.1%) receiving valsartan, and none receiving losartan (P < 0.001). CONCLUSION: Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/10(6) cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/10(6) cDDDs). Elevation of ALT was more commonly associated with fimasartan than the other ARBs. Clinicians should be aware of the possibility of ARB-related ALT elevation in patients with unexplained chronic abnormal ALT.
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spelling pubmed-94247462022-09-06 Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers Choi, Won Joon Kim, Gi-Ae Park, Jaewon Jang, Sangmi Jung, Woo Jin Shim, Jae-Jun Park, Yewan Choi, Gwang Hyeon Kim, Jin-Wook Jeong, Sook-Hyang Jang, Eun Sun J Korean Med Sci Original Article BACKGROUND: Angiotensin type II receptor blockers (ARBs) are the most widely used anti-hypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. METHODS: Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels > 5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM). RESULTS: A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels > 120 IU/L were found in 558 (2.1%) person-years, and levels > 200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation > 120 IU/L per 10(6) cumulative defined daily doses was 6.6, 3.6, 3.9, and 4.0 in the fimasartan, candesartan, valsartan, and losartan groups, respectively (P = 0.002). An ALT level > 200 IU/L with RUCAM score ≥ 6 was found in 20 patients, suggesting probable drug-induced liver injury for 11 (0.2%) patients receiving fimasartan, five (0.1%) receiving candesartan, four (0.1%) receiving valsartan, and none receiving losartan (P < 0.001). CONCLUSION: Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/10(6) cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/10(6) cDDDs). Elevation of ALT was more commonly associated with fimasartan than the other ARBs. Clinicians should be aware of the possibility of ARB-related ALT elevation in patients with unexplained chronic abnormal ALT. The Korean Academy of Medical Sciences 2022-08-17 /pmc/articles/PMC9424746/ /pubmed/35996932 http://dx.doi.org/10.3346/jkms.2022.37.e255 Text en © 2022 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Choi, Won Joon
Kim, Gi-Ae
Park, Jaewon
Jang, Sangmi
Jung, Woo Jin
Shim, Jae-Jun
Park, Yewan
Choi, Gwang Hyeon
Kim, Jin-Wook
Jeong, Sook-Hyang
Jang, Eun Sun
Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title_full Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title_fullStr Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title_full_unstemmed Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title_short Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers
title_sort incidence and pattern of aminotransferase elevation during anti-hypertensive therapy with angiotensin-ii receptor blockers
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9424746/
https://www.ncbi.nlm.nih.gov/pubmed/35996932
http://dx.doi.org/10.3346/jkms.2022.37.e255
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