TY - JOUR
T1 - Acute liver injury induced by levetiracetam and temozolomide co-treatment
AU - Khoury, Tawfik
AU - Chen, Shmuel
AU - Abu Rmeileh, Ayman
AU - Daher, Saleh
AU - Yaari, Shaul
AU - Benson, Ariel A.
AU - Cohen, Jonah
AU - Mizrahi, Meir
N1 - Publisher Copyright:
© 2016 Editrice Gastroenterologica Italiana S.r.l.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background Temozolomide (TMZ) is an alkylating agent used for treatment of brain neoplasms and levetiracetam (LEV) is a commonly used antiepileptic. When administered separately each medication has few negative side effects impacting the liver. Aims We sought to determine the risk of liver injury associated with the co-administration of TMZ and LEV. Methods A case-control study was performed comparing patients who received combination therapy of TMZ and LEV (group A) with matched controls (group B) who received monotherapy with one of either TMZ or LEV. We assessed patient demographics, laboratory results including presence of liver injury, and mortality. Results Twenty-six patients were included in group A and 68 patients were included in group B. Both groups were similar with respect to demographics and baseline liver function tests (P > 0.05). There was a significant elevation in liver enzymes in 73%, 46%, 19%, 31% and 27% of ALT, AST, ALK-P, GGT and bilirubin, respectively, in group A, as compared to elevations of 10.3%, 19%, 1.5%, 7% and 1.5%, respectively in group B (P < 0.05). One patient in group A died as a result of acute liver failure while no deaths from acute liver failure occurred in group B (P = 0.05). Univariate analysis identified combination therapy as a risk factor for liver injury. Multivariate regression showed that only co-treatment with TMZ and LEV was an independent risk factor for liver injury with an odds ratio of 19.1 (95 CI, 2.16–160). Conclusions Combination therapy with TMZ and LEV may precipitate acute liver injury and even death.
AB - Background Temozolomide (TMZ) is an alkylating agent used for treatment of brain neoplasms and levetiracetam (LEV) is a commonly used antiepileptic. When administered separately each medication has few negative side effects impacting the liver. Aims We sought to determine the risk of liver injury associated with the co-administration of TMZ and LEV. Methods A case-control study was performed comparing patients who received combination therapy of TMZ and LEV (group A) with matched controls (group B) who received monotherapy with one of either TMZ or LEV. We assessed patient demographics, laboratory results including presence of liver injury, and mortality. Results Twenty-six patients were included in group A and 68 patients were included in group B. Both groups were similar with respect to demographics and baseline liver function tests (P > 0.05). There was a significant elevation in liver enzymes in 73%, 46%, 19%, 31% and 27% of ALT, AST, ALK-P, GGT and bilirubin, respectively, in group A, as compared to elevations of 10.3%, 19%, 1.5%, 7% and 1.5%, respectively in group B (P < 0.05). One patient in group A died as a result of acute liver failure while no deaths from acute liver failure occurred in group B (P = 0.05). Univariate analysis identified combination therapy as a risk factor for liver injury. Multivariate regression showed that only co-treatment with TMZ and LEV was an independent risk factor for liver injury with an odds ratio of 19.1 (95 CI, 2.16–160). Conclusions Combination therapy with TMZ and LEV may precipitate acute liver injury and even death.
KW - Drug induced liver injury
KW - Levetiracetam
KW - Temozolomide
UR - http://www.scopus.com/inward/record.url?scp=85009206036&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2016.11.015
DO - 10.1016/j.dld.2016.11.015
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C2 - 28034663
AN - SCOPUS:85009206036
SN - 1590-8658
VL - 49
SP - 297
EP - 300
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
IS - 3
ER -