Clinical characteristics and HLA associations of azithromycin-induced liver injury.
Aliment Pharmacol Ther
; 60(6): 787-795, 2024 Sep.
Article
in En
| MEDLINE
| ID: mdl-38988034
ABSTRACT
BACKGROUND:
Azithromycin (AZ) is a widely used antibiotic. The aim of this study was to characterise the clinical features, outcomes, and HLA association in patients with drug-induced liver injury (DILI) due to AZ.METHODS:
The clinical characteristics of individuals with definite, highly likely, or probable AZ-DILI enrolled in the US Drug-Induced Liver Injury Network (DILIN) were reviewed. HLA typing was performed using an Illumina MiSeq platform. The allele frequency (AF) of AZ-DILI cases was compared to population controls, other DILI cases, and other antibiotic-associated DILI cases.RESULTS:
Thirty cases (4 definite, 14 highly likely, 12 probable) of AZ-DILI were enrolled between 2004 and 2022 with a median age of 46 years, 83% white, and 60% female. Median duration of AZ treatment was 5 days. Latency was 18.5 days. 73% were jaundiced at presentation. The injury pattern was hepatocellular in 60%, cholestatic in 27%, and mixed in 3%. Ten cases (33%) were severe or fatal; 90% of these were hepatocellular. Two patients required liver transplantation. One patient with chronic liver disease died of hepatic failure. Chronic liver injury developed in 17%, of which 80% had hepatocellular injury at onset. HLA-DQA1*0301 was significantly more common in AZ-DILI versus population controls and amoxicillin-clavulanate DILI cases (AF 0.29 vs. 0.11, p = 0.001 and 0.002, respectively).CONCLUSION:
Azithromycin therapy can lead to rapid onset of severe hepatic morbidity and mortality in adult and paediatric populations. Hepatocellular injury and younger age were associated with worse outcomes. HLA-DQA1*0301 was significantly more common in AZ cases compared to controls.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Azithromycin
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Chemical and Drug Induced Liver Injury
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Anti-Bacterial Agents
Limits:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
Aliment Pharmacol Ther
Journal subject:
FARMACOLOGIA
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GASTROENTEROLOGIA
/
TERAPIA POR MEDICAMENTOS
Year:
2024
Document type:
Article
Affiliation country: