Porphyria cutanea tarda: effects and risk factors for hepatotoxicity from high-dose chloroquine treatment.
High-dose chloroquine therapy for porphyria cutanea tarda is rarely used now because of its hepatic side-effects. The mechanisms of the effects and side-effects are poorly understood. We describe here effects, side-effects and long-term follow-up in 57 patients with a first-time diagnosis of porphyria cutanea tarda treated with 1-3 phlebotomies followed by 250 mg chloroquine phosphate daily for 7 days. A hepatotoxic reaction with high serum aminotransferases occurred in almost all patients. Within 3 months, clinical remission was obtained in all patients, and biochemical remission in almost all patients. Relapse occurred in 27 patients after 0.5-12 years. Subjective side-effects occurred more frequently in women, who also had higher maximum ALAT, ferritin and uroporphyrin values during treatment. Both subjective side-effects and ALAT during treatment correlated with pre-treatment uroporphyrin excretion and maximum uroporphyrin during treatment, but not with markers of hereditary haemochromatosis.
Rossmann-Ringdahl
Ingrid
I
Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden. Ingrid.rossmann-ringdahl@vgregion.se
Olsson
Rolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D002738:Chloroquine / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D017119:Porphyria Cutanea Tarda / Q000097:blood / Q000628:therapy* / Q000652:urine; D011166:Porphyrins / Q000652:urine; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D000637:Transaminases / Q000097:blood
D000962:Antimalarials; D011166:Porphyrins; D002738:Chloroquine; D005293:Ferritins; D000637:Transaminases; D000410:Alanine Transaminase