Antiandrogen hepatotoxicity in patients with chronic viral hepatitis.
OBJECTIVE
To assess whether patients with chronic viral hepatitis are at an increased risk for antiandrogen hepatotoxicity.


METHODS
We retrospectively reviewed 121 prostate cancer patients who received long-term antiandrogen, either flutamide (n = 56) or cyproterone acetate (n = 65), and had normal pretreatment serum alanine aminotransferase (ALT) levels. Serological markers of hepatitis B and C viruses (HBV and HCV) were checked in 42 of the 121 patients.


RESULTS
Twenty-two (18%) of the 121 patients had ALT elevations during antiandrogen therapy. Thirteen (59%) of the 22 patients were positive for either one of the two viral markers, including 7 for HBV, 4 for HCV, and 2 for both. This percentage was higher than the combined prevalence rate of positivity for HBV and/or HCV markers (<20%) in Taiwan. There was no significant differences in the percentage of positive makers among the two antiandrogen groups (p = 0.092). Although a higher incidence of hepatotoxicity was noted in the flutamide (13/56, 23%) than in the cyproterone acetate group (9/65, 14%), there were no significant differences between the two groups (p = 0.27). The time period between initiation of antiandrogen and first ALT elevation varied significantly (from 4 to 1,398 days with a median of 151 days). Half of the 14 HBV carriers and all of the 6 patients with anti-HCV developed antiandrogen hepatotoxicity.


CONCLUSIONS
Our limited data suggested that patients with chronic viral hepatitis probably are at a higher risk of developing antiandrogen hepatotoxicity. Close monitoring of liver functions in patients with chronic viral hepatitis is advised if antiandrogen therapy is necessary. However, a large-scale study is necessary for a definitive conclusion.
Pu
Y S
YS
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. yspu@ha.mc.ntu.edu.tw
Liu
C M
CM
Kao
J H
JH
Chen
J
J
Lai
M K
MK
D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D017373:Cyproterone Acetate / Q000009:adverse effects; D005485:Flutamide / Q000009:adverse effects; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000453:epidemiology; D008111:Liver Function Tests; D008297:Male; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies
D000726:Androgen Antagonists; D017373:Cyproterone Acetate; D005485:Flutamide