Antiandrogen hepatotoxicity in patients with chronic viral hepatitis

Objective: To assess whether patients with chronic viral hepatitis are at a n increased risk for antiandrogen hepatotoxicity. Methods: We retrospective ly reviewed 121 prostate cancer patients who received long-term antiandroge n, either flutamide (n = 56) or cyproterone acetate (n = 65), and had norma l pretreatment serum alanine aminotransferase (ALT) levels. Serological mar kers of hepatitis B and C viruses (HBV and HCV) were checked in 42 of the 1 21 patients. Results: Twenty-two (18%) of the 121 patients had ALI elevatio ns during antiandrogen therapy. Thirteen (59%) of the 22 patients were posi tive for either one of the two viral markers, including 7 for HBV, 4 for HC V, and 2 for both, This percentage was higher than the combined prevalence rate of positivity for HBV and/or HCV markers (<20%) in Taiwan, There was n o significant differences in the percentage of positive makers among the tw o antiandrogen groups (p = 0.092). Although a higher incidence of hepatotox icity was noted in the flutamide (13/56, 23%) than in the cyproterone aceta te group (9/65, 14%), there were no significant differences between the two groups (p = 0.27). The time period between initiation of antiandrogen and first ALT elevation varied significantly (from 4 to 1,398 days with a media n of 151 days). Half of the 14 HBV carriers and all of the 6 patients with anti-HCV developed antiandrogen hepatotoxicity. Conclusion: Our limited dat a suggested that patients with chronic viral hepatitis probably are at a hi gher risk of developing antiandrogen hepatotoxicity. Close monitoring of li ver functions in patients with chronic viral hepatitis is advised if antian drogen therapy is necessary. However, a large-scale study is necessary for a definitive conclusion.