Academic Journal
Oral Azole Antifungal Medications and Risk of Acute Liver Injury, Overall and by Chronic Liver Disease Status.
| العنوان: | Oral Azole Antifungal Medications and Risk of Acute Liver Injury, Overall and by Chronic Liver Disease Status. |
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| المؤلفون: | IIILo Re, Vincent1,2,3 vincentl@mail.med.upenn.edu, Carbonari, Dena M.2,3, Lewis, James D.2,3,4, Forde, Kimberly A.2,3,4, Goldberg, David S.2,3, Reddy, K. Rajender3,4, Haynes, Kevin2,3, Roy, Jason A.2,3, Sha, Daohang2, Marks, Amy R.5, Schneider, Jennifer L.5, Strom, Brian L.2,3,6, Corley, Douglas A.5, Lo Re, Vincent 3rd7 (AUTHOR) |
| المصدر: | American Journal of Medicine. Mar2016, Vol. 129 Issue 3, p283-291.e5. 1p. |
| مصطلحات موضوعية: | *LIVER injuries, *AZOLES, *LIVER disease diagnosis, *KETOCONAZOLE, *FLUCONAZOLE, *LIVER diseases, *INJURY risk factors, *THERAPEUTICS, *DISEASE risk factors, *AMINOTRANSFERASES, *ANTIFUNGAL agents, *CHRONIC diseases, *HEPATITIS, *HETEROCYCLIC compounds, *LIVER failure, *LONGITUDINAL method, *ORAL drug administration, *RETROSPECTIVE studies, *ACUTE diseases |
| مصطلحات جغرافية: | CALIFORNIA |
| مستخلص: | |
| قاعدة البيانات: | Academic Search Index |
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asx Academic Search Index 112977030 1121 6 Academic Journal academicJournal 1121.05847167969 |
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https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=asx&AN=112977030&custid=s6537998&authtype=sso |
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Array ( [Name] => Author [Label] => Authors [Group] => Au [Data] => <searchLink fieldCode="AR" term="%22IIILo+Re%2C+Vincent%22">IIILo Re, Vincent</searchLink><relatesTo>1,2,3</relatesTo><i> vincentl@mail.med.upenn.edu</i><br /><searchLink fieldCode="AR" term="%22Carbonari%2C+Dena+M%2E%22">Carbonari, Dena M.</searchLink><relatesTo>2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Lewis%2C+James+D%2E%22">Lewis, James D.</searchLink><relatesTo>2,3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Forde%2C+Kimberly+A%2E%22">Forde, Kimberly A.</searchLink><relatesTo>2,3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Goldberg%2C+David+S%2E%22">Goldberg, David S.</searchLink><relatesTo>2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Reddy%2C+K%2E+Rajender%22">Reddy, K. Rajender</searchLink><relatesTo>3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Haynes%2C+Kevin%22">Haynes, Kevin</searchLink><relatesTo>2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Roy%2C+Jason+A%2E%22">Roy, Jason A.</searchLink><relatesTo>2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Sha%2C+Daohang%22">Sha, Daohang</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Marks%2C+Amy+R%2E%22">Marks, Amy R.</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Schneider%2C+Jennifer+L%2E%22">Schneider, Jennifer L.</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Strom%2C+Brian+L%2E%22">Strom, Brian L.</searchLink><relatesTo>2,3,6</relatesTo><br /><searchLink fieldCode="AR" term="%22Corley%2C+Douglas+A%2E%22">Corley, Douglas A.</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Lo+Re%2C+Vincent+3rd%22">Lo Re, Vincent 3rd</searchLink><relatesTo>7</relatesTo> (AUTHOR) ) Array ( [Name] => TitleSource [Label] => Source [Group] => Src [Data] => <searchLink fieldCode="JN" term="%22American+Journal+of+Medicine%22">American Journal of Medicine</searchLink>. Mar2016, Vol. 129 Issue 3, p283-291.e5. 1p. ) Array ( [Name] => Subject [Label] => Subject Terms [Group] => Su [Data] => *<searchLink fieldCode="DE" term="%22LIVER+injuries%22">LIVER injuries</searchLink><br />*<searchLink fieldCode="DE" term="%22AZOLES%22">AZOLES</searchLink><br />*<searchLink fieldCode="DE" term="%22LIVER+disease+diagnosis%22">LIVER disease diagnosis</searchLink><br />*<searchLink fieldCode="DE" term="%22KETOCONAZOLE%22">KETOCONAZOLE</searchLink><br />*<searchLink fieldCode="DE" term="%22FLUCONAZOLE%22">FLUCONAZOLE</searchLink><br />*<searchLink fieldCode="DE" term="%22LIVER+diseases%22">LIVER diseases</searchLink><br />*<searchLink fieldCode="DE" term="%22INJURY+risk+factors%22">INJURY risk factors</searchLink><br />*<searchLink fieldCode="DE" term="%22THERAPEUTICS%22">THERAPEUTICS</searchLink><br />*<searchLink fieldCode="DE" term="%22DISEASE+risk+factors%22">DISEASE risk factors</searchLink><br />*<searchLink fieldCode="DE" term="%22AMINOTRANSFERASES%22">AMINOTRANSFERASES</searchLink><br />*<searchLink fieldCode="DE" term="%22ANTIFUNGAL+agents%22">ANTIFUNGAL agents</searchLink><br />*<searchLink fieldCode="DE" term="%22CHRONIC+diseases%22">CHRONIC diseases</searchLink><br />*<searchLink fieldCode="DE" term="%22HEPATITIS%22">HEPATITIS</searchLink><br />*<searchLink fieldCode="DE" term="%22HETEROCYCLIC+compounds%22">HETEROCYCLIC compounds</searchLink><br />*<searchLink fieldCode="DE" term="%22LIVER+failure%22">LIVER failure</searchLink><br />*<searchLink fieldCode="DE" term="%22LONGITUDINAL+method%22">LONGITUDINAL method</searchLink><br />*<searchLink fieldCode="DE" term="%22ORAL+drug+administration%22">ORAL drug administration</searchLink><br />*<searchLink fieldCode="DE" term="%22RETROSPECTIVE+studies%22">RETROSPECTIVE studies</searchLink><br />*<searchLink fieldCode="DE" term="%22ACUTE+diseases%22">ACUTE diseases</searchLink> ) Array ( [Name] => SubjectGeographic [Label] => Geographic Terms [Group] => Su [Data] => <searchLink fieldCode="DE" term="%22CALIFORNIA%22">CALIFORNIA</searchLink> ) Array ( [Name] => Abstract [Label] => Abstract [Group] => Ab [Data] => <bold>Background: </bold>Reports on associations between azole antifungal medications and acute liver injury are inconsistent and have not been based on liver-related laboratory tests. We evaluated incidence rates of acute liver injury associated with oral azole antifungals.<bold>Methods: </bold>We conducted a cohort study among Kaiser Permanente Northern California members who initiated an oral azole antifungal in an outpatient setting during 2004-2010. We determined development of: (1) liver aminotransferases >200 U/L, (2) severe acute liver injury (coagulopathy with hyperbilirubinemia), and (3) acute liver failure. We calculated incidence rates of endpoints. Cox regression was used to determine whether chronic liver disease was a risk factor for outcomes.<bold>Results: </bold>Among 195,334 azole initiators (178,879 fluconazole; 14,296 ketoconazole; 1653 itraconazole; 478 voriconazole; 28 posaconazole), incidence rates (events/1000 person-years [95% confidence intervals (CIs)]) of liver aminotransferases >200 U/L were similarly low with fluconazole (13.0 [11.4-14.6]), ketoconazole (19.3 [13.8-26.3]), and itraconazole (24.5 [10.6-48.2]). Rates were higher with voriconazole (181.9 [112.6-278.0]) and posaconazole (191.1 [23.1-690.4]), but comparable. Severe acute liver injury was uncommon with fluconazole (2.0 [1.4-2.7]), ketoconazole (2.9 [1.1-6.3]), and itraconazole (0.0 [0.0-11.2]), but more frequent with voriconazole (16.7 [2.0-60.2]) and posaconazole (93.4 [2.4-520.6]). One patient developed acute liver failure due to ketoconazole. Pre-existing chronic liver disease increased risks of aminotransferases >200 U/L (hazard ratio 4.68 [95% CI, 3.68-5.94]) and severe acute liver injury (hazard ratio 5.62 [95% CI, 2.56-12.35]).<bold>Conclusions: </bold>Rates of acute liver injury were similarly low for fluconazole, ketoconazole, and itraconazole. Events were more common among voriconazole and posaconazole users but were comparable. Pre-existing chronic liver disease increased risk of azole-induced liver injury. [ABSTRACT FROM AUTHOR] ) |
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