Fatal liver failure associated with pioglitazone
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7463.429 (Published 19 August 2004) Cite this as: BMJ 2004;329:429
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Sir,
Ed Farley-Hills et al report a case of fatal liver failure (BMJ 2004;
329 : 429) thought likely due to pioglitazone.However alternative
aetiology to the cause of hepatic failure seems more likely in this
case.The histopathology findings are descibed consistent with chronic
liver disease and the relatively short time of exposure to pioglitazone
militate against pioglitazone beeing the likely cause of hepatic failure
which seems more likely secondary to a chronic pathology possibly a
combination of diabetic hepatic steatosis and alcohol.
This case report should ,however, be a reminder to the importance of
monitoring liver function before and during glitozones therapy.
Competing interests:
Recieved honararia for lecturing from Tackeda
Competing interests: No competing interests
The case report by Ed Farley-Hills and colleagues is interesting.
While I hope reminding health care physicians to monitor liver function
test (LFT) but not to cause scare similar to that happened to
troglitazone several years ago.
In actual fact there are missing data from this case report. For
example there was no mention of liver function test before initiation of
pioglitazone and whether LFT profile monitored after that. The Nice
guidance and BNF both recommended that as well as the manufacturers [1].
No details about glycaemic control before blaming his diabetes as a
cause for this amount of sever liver failure. Was there any reaction to
gliclazide before like abnormal LFT as gliclazide reported before to cause
liver draingment?
Lastly it seems from histopathology report that it was more chronic
liver disease with amount of fibrosis. Either the clinician failed to
follow the guidelines or our LFT screening test is not robust enough to
pick up such disorder and avoiding thiazolidinediones.
[1] Nice Gudiance on the use of glitazones for the tratment of type 2
diabetes (August 2003) Technology APPRIASAL 63.
Competing interests:
Delivered lectures to PCT sponored by Takeda
Competing interests: No competing interests
Dear Sir
Given the suspected and devastating effect of this particular drug
(or perhaps it is an effect of the whole group of glitazones), can we now
expect a world or nationwide ban and recall of this and related drugs?
If this were the effect of a complementary medicine the western
medical authoritys' usual response would be a rapid if not instant ban
and/or recall as has been the case with any damage alleged to have been
caused by herbal or traditional medicines (e.g Tryptophan; The Pan recall
after the Travacalm issue etc )?
Why is it then that when deaths are attributable to drug use that
these bans / recalls do not occur. The answer of course is that we the
profession, are bewitched by the drug companys' propaganda and the playing
fields are not level.
yours
Philip Stowell
Fellow of The Australasian College if Nutrition and Environmental Medicine
Competing interests:
I have an interest in fairness and equality of regulation; a concern that patients get treated with respect and I work in Nutritional Medicine
Competing interests: No competing interests
Re: Do we need a ban or recall ?
Dear Dr Stowell,
Thank you for your response to my article. I think it is too early to say
whether there should be a ban on this drug.This drug is still under
surveillance so a decision will need to be made if more evidence emerges.
Yours
Ed Farley-Hills
Competing interests:
none
Competing interests: No competing interests