title: Antiandrogen hepatotoxicity in patients with chronic viral hepatitis.
abstract: 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.
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. yspu@ha.mc.ntu.edu.tw
authors.forename: Y S
authors.initials: YS
authors.lastname: Pu
authors.forename: C M
authors.initials: CM
authors.lastname: Liu
authors.forename: J H
authors.initials: JH
authors.lastname: Kao
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: M K
authors.initials: MK
authors.lastname: Lai
mesh_terms: 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
chemical_list: D000726:Androgen Antagonists; D017373:Cyproterone Acetate; D005485:Flutamide