Supramolecular materials: longer and safer gastric residence

A supramolecular polymer that is stable in the acidic environment of the stomach but dissolves in the neutral-pH environment of the intestines prolongs the safe retention of gastric devices

Presentation and Outcomes with Clinically Apparent Interferon Beta Hepatotoxicity

AIMS: The aim of this study was to describe the presenting features and outcomes of consecutive patients with liver injury attributed to interferon beta. METHODS: The presenting features of 8 subjects with clinically apparent liver injury attributed to interferon beta enrolled in the U.S. Drug-Induced Liver Injury Network (DILIN) prospective registry between 2004 and 2010 were reviewed and compared to 11 published reports of symptomatic hepatotoxicity. RESULTS: All 8 of the DILIN patients were women, 75% were Caucasian and the mean age was 49 years. Most subjects presented with an acute hepatocellular injury pattern and mean serum alanine aminotransferase (ALT) levels were 725 ± 593 U/L. The median duration of interferon beta use before injury onset was 462 days, and 4 patients had been treated for more than a year. No patient had detectable antinuclear or smooth muscle antibodies. One patient died of acute liver failure and the remaining patients usually recovered within 2 to 3 months. Causality assessment scored 3 cases as definite, 3 highly likely, 1 probable and 1 possible. Eleven additional published cases were all women, mean age was 40 years, mean ALT at onset 840 U/L, and 7 (63%) had autoantibodies. Liver histology in 3 cases from DILIN and 9 from the literature commented upon centri-lobular (zone 3) necrosis and infiltrates with lymphocytes and plasma cells. CONCLUSIONS: Interferon beta hepatotoxicity occurs mostly in women and has a variable, but often prolonged time to onset. Most patients have self-limited acute hepatocellular liver injury but several have required liver transplantation or died of acute liver failure. Liver histology available in 3 cases demonstrated zone 3 necrosis and autoimmune features suggestive of an immunologic basis to this adverse drug reaction