Individualización de dosis en el paciente oncológico con insuficiencia hepática / Customization of doses in oncological patients with impaired hepatic function

Objetivo: determinar qué citostáticos requieren ajuste de dosis en pacientes con insuficiencia hepática. Métodos: se realizó una búsqueda en PubMed de toda la bibliografía publicada hasta julio de 2011 sobre dosificación de citostáticos en pacientes con función hepática alterada. Se procedió a su valoración según la clasificación de la Scottish Intercollegiate Guidelines Network. Se sintetizó un índice de fuerza de la recomendación farmacoterapéutica, para lo que se asoció el grado de recomendación de la evidencia encontrada y el número de pacientes incluidos en los estudios encontrados. Se clasificó la recomendación para cada fármaco como de fuerza alta, media o baja. Resultados: se encontraron un total de 46 publicaciones con información sobre dosificación en pacientes con insuficiencia hepática para un total de 17 citostáticos. El 67 por ciento (n= 31) de las publicaciones fueron estudios de cohortes con un nivel de evidencia 2+. No pudieron establecerse recomendaciones de fuerza alta, pero sí de fuerza moderada (76 por ciento; 13 fármacos) y baja (24 por ciento; 4 fármacos). Conclusiones: aunque el nivel de la evidencia disponible fue bajo, podrían establecerse recomendaciones sobre la dosificación de citostáticos en pacientes con insuficiencia hepática para mejorar la seguridad en el uso de estos fármacos en el referido grupo de enfermos(AU)

Objective: to determine the cytostatic drugs requiring dose adjustment in patients with impaired hepatic function. Methods: aliterature review of all the papers about dosage of cytostatic drug in patients with impaired hepatic function published till July 2011 in Pubmed search was made. They were assessed as rated by the Scottish Intercollegiate Guidelines Network. An index of pharmacotherapy recommendation strength was developed, for which the grade of recommendation of the evidence found and the number of patients included in the studies were then correlated, ranking the strength of recommendation for each drug as high, medium or low. Results: atotal of 46 publications with information about dosing in liver failure were found for 17 cytostatic drugs. Sixty seven percent (n= 31) of the publications were cohort studies with a level of evidence 2+. High strength recommendations could not been established, but moderate strength (76 percent; 13 drugs) and low strength (24 percent; 4 drugs) recommendations were finally established. Conclusions: although level of evidence was low, dosage recommendations of cytostatic drugs to be used in liver failure patients were established to improve safety in the use of these drugs in the stated group of patients(AU)

Steroid therapy in fulminant hepatic failure secondary to autoimmune hepatitis

Autoimmune hepatitis is a chronic inflammatory liver disorder of unknown etiology associated with serum autoantibodies and hypergammaglobulinemia. This disease has a broad spectrum of presentations ranging from asymptomatic to fulminant hepatic failure. A 36 year old female with past history of hypothyroidism developed jaundice 2 months prior to admission. Outpatient evaluation revealed ANA and anti-SMA antibodies in high titers, negative viral markers for hepatitis, and hypergammaglobulinemia. A presumptive diagnosis of autoimmune hepatitis was made; steroids were recommended but the patient did not take them. She was admitted to the University Hospital due to increased jaundice, general malaise and ascites 5 weeks later. She deteriorated developing coagulopathy, encephalopathy and increasing hyperbilirubinemia. Intravenous corticosteroids were started. The patient improved and was discharged 3 weeks after admission. Fulminant hepatic failure has a high mortality and may require liver transplant. Our patient survived fulminant hepatic failure that resolved after corticosteroid therapy. It is important to identify and distinguish autoimmune hepatitis from other forms of liver disease because of the high percentage of response to immuno-suppressive therapy. Early diagnosis and treatment of this condition could improve survival, quality of life, and defer liver transplantation.