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논문 기본 정보

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저자정보
Choi Won Joon (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Kim Gi-Ae (Department of Internal Medicine Kyung Hee University Medical Center Seoul Korea.) Park Jaewon (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Jang Sangmi (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Jung Woo Jin (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Shim Jae-Jun (Department of Internal Medicine Kyung Hee University Medical Center Seoul Korea.) Park Yewan (Department of Internal Medicine Kyung Hee University Medical Center Seoul Korea.) Choi Gwang Hyeon (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Kim Jin-Wook (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Jeong Sook-Hyang (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer) Jang Eun Sun (Department of Internal Medicine Seoul National University College of Medicine Seoul National Univer)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.37 No.33
발행연도
2022.8
수록면
1 - 11 (11page)
DOI
10.3346/jkms.2022.37.e255

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Background: Angiotensin type II receptor blockers (ARBs) are the most widely used antihypertensive 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 106 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 (4.24/106 cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/106 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.
#Chemical and Drug Induced Liver Injury #Angiotensin II Type 2 Receptor Blockers #Alanine Transaminase #Liver Function Tests #Fimasartan

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