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Identification and Characterization of Fenofibrate-Induced Liver Injury.

Publication ,  Journal Article
Ahmad, J; Odin, JA; Hayashi, PH; Chalasani, N; Fontana, RJ; Barnhart, H; Cirulli, ET; Kleiner, DE; Hoofnagle, JH
Published in: Dig Dis Sci
December 2017

BACKGROUND: Fenofibrate is a commonly used hypolipidemic associated with rare instances of hepatotoxicity, and routine liver biochemistry monitoring is recommended. AIMS: The aim of this study is to describe the presenting clinical features, liver histopathology, and outcomes of 7 cases of acute liver injury associated with fenofibrate. METHODS: All cases of definite, very likely, and probable drug-induced liver injury (DILI) attributed to fenofibrate enrolled in the DILI Network study between 2004 and 2015 were reviewed. RESULTS: Among 1229 patients with confirmed DILI, 7 cases (0.6%) were attributed to fenofibrate. The median age was 43 (range 37-61) years, and latency to onset was short (5-8 weeks) in 4 patients but more prolonged (18-56 weeks) in the rest. Laboratory results at presentation showed hepatocellular, mixed, and cholestatic injury, but 6 cases presented with jaundice. No patient had undergone routine monitoring. Four patients required hospitalization and 2 in whom drug discontinuation was delayed had a severe outcome, 1 undergoing liver transplantation, and 1 developing chronic injury and death. Liver biopsy was available in 4 patients and showed diverse injury patterns. Genetic studies showed the presence of the rare HLA-A*33:01 in 3 patients (43 vs. 1% in control populations). The causality scores were highly likely in 5 and probable in 2. CONCLUSIONS: Liver injury after fenofibrate exposure occurs with variable latency, enzyme elevation, and histology. Although most cases are self-limited, severe injury and mortality can occur, particularly if drug withdrawal is delayed. Jaundice or abnormal laboratory tests during fenofibrate therapy should trigger prompt discontinuation.

Duke Scholars

Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

December 2017

Volume

62

Issue

12

Start / End Page

3596 / 3604

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Liver
  • Hypolipidemic Agents
  • Humans
  • HLA-A Antigens
  • Gastroenterology & Hepatology
  • Fenofibrate
  • Female
  • Chemical and Drug Induced Liver Injury
 

Citation

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Ahmad, J., Odin, J. A., Hayashi, P. H., Chalasani, N., Fontana, R. J., Barnhart, H., … Hoofnagle, J. H. (2017). Identification and Characterization of Fenofibrate-Induced Liver Injury. Dig Dis Sci, 62(12), 3596–3604. https://doi.org/10.1007/s10620-017-4812-7
Ahmad, Jawad, Joseph A. Odin, Paul H. Hayashi, Naga Chalasani, Robert J. Fontana, Huiman Barnhart, Elizabeth T. Cirulli, David E. Kleiner, and Jay H. Hoofnagle. “Identification and Characterization of Fenofibrate-Induced Liver Injury.Dig Dis Sci 62, no. 12 (December 2017): 3596–3604. https://doi.org/10.1007/s10620-017-4812-7.
Ahmad J, Odin JA, Hayashi PH, Chalasani N, Fontana RJ, Barnhart H, et al. Identification and Characterization of Fenofibrate-Induced Liver Injury. Dig Dis Sci. 2017 Dec;62(12):3596–604.
Ahmad, Jawad, et al. “Identification and Characterization of Fenofibrate-Induced Liver Injury.Dig Dis Sci, vol. 62, no. 12, Dec. 2017, pp. 3596–604. Pubmed, doi:10.1007/s10620-017-4812-7.
Ahmad J, Odin JA, Hayashi PH, Chalasani N, Fontana RJ, Barnhart H, Cirulli ET, Kleiner DE, Hoofnagle JH. Identification and Characterization of Fenofibrate-Induced Liver Injury. Dig Dis Sci. 2017 Dec;62(12):3596–3604.
Journal cover image

Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

December 2017

Volume

62

Issue

12

Start / End Page

3596 / 3604

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Liver
  • Hypolipidemic Agents
  • Humans
  • HLA-A Antigens
  • Gastroenterology & Hepatology
  • Fenofibrate
  • Female
  • Chemical and Drug Induced Liver Injury