Liver Cancer
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 15, 2003; 9(12): 2681-2685
Published online Dec 15, 2003. doi: 10.3748/wjg.v9.i12.2681
Side effects of budesonide in liver cirrhosis due to chronic autoimmune hepatitis: influence of hepatic metabolism versus portosystemic shunts on a patient complicated with HCC
Andreas Geier, Carsten Gartung, Christoph G. Dietrich, Hermann E. Wasmuth, Patrick Reinartz, Siegfried Matern
Andreas Geier, Carsten Gartung, Christoph G. Dietrich, Hermann E. Wasmuth, Siegfried Matern, Department of Internal Medicine III, University of Technology (RWTH) Aachen, Aachen, Germany
Patrick Reinartz, Nuclear Medicine, University of Technology (RWTH) Aachen, Aachen, Germany
Author contributions: All authors contributed equally to the work.
Supported by Falk Pharma, Freiburgi. Br., Germany
Correspondence to: Andreas Geier, MD, Department of Internal Medicine III, University of Technology Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. ageier@ukaachen.de
Telephone: +49-241-8088634 Fax: +49-241-8082455
Received: July 12, 2003
Revised: July 26, 2003
Accepted: September 13, 2003
Published online: December 15, 2003
Abstract

AIM: To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma, who developed serious side effects.

METHODS: Serum levels of budesonide, 6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging. All values were compared with a matched control patient without side effects.

RESULTS: Serum levels of budesonide were 13-fold increased in the index patient. The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH-prednisolone, respectively, and serum levels of budesonide was diminished (1.0 vs. 4.0 for 6β-OH-budesonide, 4.2 vs. 10.7 for 16α-OH-prednisolone). Both patients had portosystemic SI (5.7% and 3.1%) within the range of healthy subjects.

CONCLUSION: Serum levels of budesonide vary up to 13-fold in AIH patients with Child A cirrhosis in the absence of relevant portosystemic shunting. Reduced hepatic metabolism, as indicated by reduced metabolite-to-drug ratio, rather than portosystemic shunting may explain systemic side effects of this drug in cirrhosis.

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