title: Glatiramer acetate induced hepatotoxicity.
abstract: BACKGROUND
  Glatiramer acetate (Copaxone), a polypeptide has been approved for treating patients with active relapsing-remitting multiple sclerosis.
  
  
  METHODS
  We report the first case of severe acute hepatitis after commencing treatment for multiple sclerosis with glatiramer acetate. A 31-year-old female with multiple sclerosis presented with anorexia, lethargy and jaundice five weeks after commencing glatiramer acetate. She had never received beta-interferon treatment. Investigations revealed a bilirubin of 0.109 mmol/L (0.002-0.02 mmoL/L) and prothrombin time of 21 secs (9-15 secs). Her liver function tests were normal before commencing glatiramer acetate. A liver biopsy performed approximately 6 weeks after commencement of glatiramer acetate showed predominantly centrilobular hepatocyte necrosis with portal-venous bridging, along with mild portal and interface hepatitis. The necrosis was not accompanied by an acute inflammatory or chronic inflammatory infiltrate. The features were not suggestive of autoimmune hepatitis but consistent with drug toxicity. The liver tests returned to normal within 2 months after cessation of glatiramer acetate.
  
  
  CONCLUSIONS
  Physicians should be aware that glatiramer acetate can be associated with uncommon but yet significantly severe liver toxicity.
authors.affiliation: Gastroenterology and Hepatology Unit, Canberra Hospital, ACT, Australia. kaviths@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Subramaniam
authors.forename: P
authors.initials: P
authors.lastname: Pavli
authors.forename: H
authors.initials: H
authors.lastname: Llewellyn
authors.forename: S
authors.initials: S
authors.lastname: Chitturi
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D005260:Female; D000068717:Glatiramer Acetate; D022781:Hepatocytes / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008111:Liver Function Tests; D009103:Multiple Sclerosis / Q000188:drug therapy; D009336:Necrosis; D010455:Peptides / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D010455:Peptides; D000068717:Glatiramer Acetate