Expert opinion on drug safety · 2008
Safety issues in the management of autoimmune hepatitis.
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Czaja Albert J
Аннотация
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.
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.