Troglitazone-Associated Hepatic Failure

Brent A. Neuschwander-Tetri; William L. Isley; Julie C. Oki

doi:10.7326/0003-4819-130-4-199902160-00010

Letters |16 February 1999

Troglitazone-Associated Hepatic Failure

Brent A. Neuschwander-Tetri, MD; William L. Isley, MD; Julie C. Oki, PharmD

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IN RESPONSE:

Dr. Misbin's update on troglitazone hepatotoxicity based on reports to the FDA is indeed worrisome. It would appear that some patients can experience an unpredictable yet fatal progression of liver disease well into the course of treatment. Delayed elevation of liver enzyme levels was noted in the initial published review of the clinical trials data (1), yet the analysis of this relatively small and well-controlled initial experience led to the conclusion that the enzyme changes were uniformly reversible (2). If minor elevations in ALT levels (<3 times the upper limit of normal) can be a harbinger of liver failure in some patients, as suggested by the experience reported by Dr. Misbin, then a little more fear and attentiveness are needed on the part of all prescribers than was suggested by the early conclusions (2). The erratic progression of liver disease documented by this case and the observation that continued hepatocellular injury can progress even weeks after discontinuation of troglitazone therapy only re-emphasizes the need to closely follow all patients treated with this drug for the development of any liver enzyme abnormalities well into the course of treatment.

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Letters |16 February 1999

Troglitazone-Associated Hepatic Failure

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Letters |16 February 1999

Troglitazone-Associated Hepatic Failure

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