托法替布致幼年特发性关节炎患儿肝损伤  

Liver injury caused by tofacitinib in a child with juvenile idiopathic arthritis

作　　者：熊亚群 周仕海 肖幸华 罗平 Xiong Yaqun;Zhou Shihai;Xiao Xinghua;Luo Ping(Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Pharmacy,Guihang Guiyang Hospital,Guiyang 550001,China;Department of Pharmacy,Xiangya Changde Hospital,Hunan Province,Changde 415009,China)

机构地区：[1]中南大学湘雅医院药学部,长沙410008 [2]贵航贵阳医院药剂科,贵阳550001 [3]湘雅常德医院药剂科,常德415009

出　　处：《药物不良反应杂志》2022年第5期266-268,共3页Adverse Drug Reactions Journal

摘　　要：1例11岁男性患儿因幼年特发性关节炎控制不佳,在甲氨蝶呤(10 mg口服、1次/周)治疗基础上联用托法替布(7.5 mg口服、1次/d),症状缓解。联用托法替布前患儿肝功能正常,2药联用2个月余,实验室检查示丙氨酸转氨酶(ALT)178 U/L、天门冬氨酸转氨酶(AST)78 U/L。因无临床症状,未予干预。继续用药1个月后,ALT 586 U/L、AST 170 U/L。排除病毒性肝炎、自身免疫性肝炎等原因后,考虑为药物性肝损伤。停用甲氨蝶呤,加用托珠单抗,并给予还原型谷胱甘肽和异甘草酸镁治疗,11 d后患儿肝功能检查示ALT 512 U/L、AST 194 U/L;停用托法替布,3 d后ALT 150 U/L、AST 41 U/L。考虑肝损伤为托法替布所致。继续护肝治疗1周,患儿ALT 41 U/L、AST 35 U/L。An 11-year-old boy received tofacitinib(oral 7.5 mg once daily)on the basis of methotrexate therapy(oral 10 mg once a week)due to poor control of juvenile idiopathic arthritis,and the symptoms were relieved.The boy's liver function was normal before using tofacitinib.After more than 2 months of combined use of the 2 drugs,laboratory tests showed alanine aminotransferase(ALT)178 U/L and aspartate aminotransferase(AST)78 U/L.No intervention was given because there were no clinical symptoms.His liver enzyme elevated significantly(ALT 586 U/L,AST 170 U/L)after continued medication for 1 month.After excluding viral hepatitis,autoimmune hepatitis,and other liver diseases,drug-induced liver injury was considered.Methotrexate was discontinued,tocilizumab was added,and liver protection therapy with reduced glutathione and magnesium isoglycyrrhizinate was given.Eleven days of methotrexate withdrawal,the laboratory tests showed ALT 512 U/L and AST 194 U/L.Then tofacitinib was discontinued and hepatic enzyme decreased significantly(ALT 150 U/L,AST 41 U/L)3 days later.The liver injury was considered to be related to tofacitinib.The liver protection therapy was continued for 1 week,and the liver function examination showed ALT 41 U/L and AST 35 U/L.

关 键 词：关节炎 幼年型类风湿 Janus激酶类 化学和药物性肝损伤 超说明书用药 托法替布 

分 类 号：R725.9[医药卫生—儿科]