Arthritis patients with rare polymorphisms risk acute hepatitis with leflunomide

(Acute Drug Effects-March 22, 2004)

"Leflunomide, a new immunomodulatory agent, was prescribed to a 67-year-old female patient with rheumatoid arthritis. Fifteen days later she developed diarrhea and elevated liver enzymes. A liver biopsy showed a pattern of acute hepatitis," scientists in Spain report.

"The patient was homozygous for the rare CYP2C9*3 allele, which determines the slowest metabolic rate for CYP2C9 enzymatic activity that is probably involved in the metabolism of leflunomide," explained C. Sevilla-Mantilla and colleagues, Complutense University, Madrid, Gastroenterology Service.

"Liver damage subsided in a few weeks. This case illustrates the risk of hepatotoxicity by leflunomide and suggests that it is possibly related to CYP2C9 polymorphism," investigators advised.

Sevilla-Mantilla and colleagues published their study in Digestive and Liver Disease (Leflunomide-induced acute hepatitis. Dig Liver Dis, 2004;36(1):82-84).

For more information, contact J.M. Ladero, University Complutense Madrid, Gastroenterology Service, Hospital Clinical San Carlos, Ciudad University, E-28040 Madrid, Spain.

The information in this article comes under the major subject areas of Immunotherapy, Gastroenterology, Hepatology, Rheumatology, and Pain Medicine. This article was prepared by Gastroenterology Week editors from staff and other reports.

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