Troglitazone-Associated Hepatic Failure
Authors: Brent A. Neuschwander-Tetri
Journal: Annals of Internal Medicine (1999)

Letters16 February 1999Troglitazone-Associated Hepatic FailureBrent A. Neuschwander-Tetri, MD, William L. Isley, MD, and Julie C. Oki, PharmDBrent A. Neuschwander-Tetri, MDSt. Louis University School of Medicine; St. Louis, MO 63110 (Neuschwander-Tetri)St. Lukes Hospital; Kansas City, MO 64111 (Isley)University of Missouri-Kansas City School of Medicine; Kansas City, MO 64108 (Oki)Search for more papers by this author, William L. Isley, MDSt. Louis University School of Medicine; St. Louis, MO 63110 (Neuschwander-Tetri)St. Lukes Hospital; Kansas City, MO 64111 (Isley)University of Missouri-Kansas City School of Medicine; Kansas City, MO 64108 (Oki)Search for more papers by this author, and Julie C. Oki, PharmDSt. Louis University School of Medicine; St. Louis, MO 63110 (Neuschwander-Tetri)St. Lukes Hospital; Kansas City, MO 64111 (Isley)University of Missouri-Kansas City School of Medicine; Kansas City, MO 64108 (Oki)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-4-199902160-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Misbin's update on troglitazone hepatotoxicity based on reports to the FDA is indeed worrisome. It would appear that some patients can experience an unpredictable yet fatal progression of liver disease well into the course of treatment. Delayed elevation of liver enzyme levels was noted in the initial published review of the clinical trials data (1), yet the analysis of this relatively small and well-controlled initial experience led to the conclusion that the enzyme changes were uniformly reversible (2). If minor elevations in ALT levels (<3 times the upper limit of normal) can be a harbinger of liver ...References1. Watkins PB, Whitcomb RW. Hepatic dysfunction associated with troglitazone [Letter]. N Engl J Med. 1998;338:916-7. CrossrefMedlineGoogle Scholar2. Imura H. A novel antidiabetic drug, troglitazone—reason for hope and concern [Editorial]. N Engl J Med. 1998;338:908-9. CrossrefMedlineGoogle Scholar3. Intensive bloo d-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study Group. Lancet. 1998; 352:837-53. Google Scholar4. Riddle MC. Learning to use troglitazone [Editorial]. Diabetes Care. 1998;21:1389-90. CrossrefMedlineGoogle Scholar5. Schwartz S, Raskin P, Fonseca V, Graveline JF. Effect of troglitazone in insulin-treated patients with type II diabetes mellitus. Troglitazone and Exogenous Insulin Study Group. N Engl J Med. 1998;338:861-6. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Brent A. Neuschwander-Tetri, MD; William L. Isley, MD; Julie C. Oki, PharmDAffiliations: St. Louis University School of Medicine; St. Louis, MO 63110 (Neuschwander-Tetri)St. Lukes Hospital; Kansas City, MO 64111 (Isley)University of Missouri-Kansas City School of Medicine; Kansas City, MO 64108 (Oki) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTroglitazone-Induced Hepatic Failure Leading to Liver Transplantation: A Case Report Brent A. Neuschwander-Tetri , William L. Isley , Julie C. Oki , Sanjay Ramrakhiani , Stella G. Quiason , Nancy J. Phillips , and Elizabeth M. Brunt Troglitazone-Associated Hepatic Failure Robert I. Misbin Metrics Cited byEvaluating the Safety of Diabetes Drugs: Perspective of a Food and Drug Administration insider 16 February 1999Volume 130, Issue 4_Part_1Page: 330KeywordsAlanine aminotransferaseClinical trialsDrug therapyEnzymesFearFood and Drug AdministrationInsulinLiverLiver diseasesProspective studies ePublished: 15 August 2000 Issue Published: 16 February 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...