Failure to Develop Hepatic Injury From Rosiglitazone in a Patient With a History of Troglitazone-Induced Hepatitis
- M. James Lenhard, MD and
- William B. Funk, MD
- From the Section of Endocrinology and Metabolism (M.J.L.), Diabetes and Metabolic Diseases Center, Christiana Care Health Services; and Department of Family Practice (W.B.F.), Saint Francis Hospital, Wilmington, Delaware; and the Department of Medicine (M.J.L.), Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
- Address correspondence to M. James Lenhard, Chief, Section of Endocrinology and Metabolism, Director, Diabetes and Metabolic Diseases Center, Christiana Care Health Services, 700 Lea Blvd., Ste. 300, Wilmington, DE 19802. E-mail: jlenhard{at}christianacare.org .
The thiazolidinediones (TZDs) are an important class of antidiabetic drugs that improve glycemic control by improving sensitivity to insulin (1). The first agent in this class was troglitazone, which has been associated with idiosyncratic hepatotoxicity that included cases of liver failure, liver transplantation, and death (2,3). Troglitazone was voluntarily withdrawn from the market in the U.S. in March 2000. Two additional second-generation agents in this class remain on the market: rosiglitazone maleate (Avandia; SmithKline Beecham Pharmaceuticals) and pioglitazone (Actos; Takeda Pharmaceuticals America/Eli Lilly and Co.). Post-marketing surveillance by the manufacturers of the second-generation TZDs have shown no confirmed hepatotoxicity with either agent. Two isolated cases of drug-induced liver disease with rosiglitazone have been reported (4,5), although some debate over the strength of this association has been raised (6). We present a case of a patient with extreme insulin resistance who developed classic troglitazone-induced liver disease but showed no signs of this while on rosiglitazone.
Case report
A 36-year-old woman presented with crampy abdominal pain and evidence of jaundice. She had a 4-year history of uncomplicated type 2 diabetes, initially treated with glyburide and acarbose. Insulin was required, and she was eventually treated with 35 U of U-500 insulin twice a day. Troglitazone 400 …
