Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An inhibitor of xanthine dehydrogenase (XDH), allopurinol, and uricosuric agents, probenecid and benzbromarone, have been used for more than 20 years in the treatment of hyperuricemia and gout. However, they are inconvenient in some situations. With regard to allopurinol, the dosage reduction is recommended in patients with renal insufficiency for preventing from rare adverse effect, bone marrow depression. Benzbromarone also has quite rare adverse effect, fulminant hepatitis. Recently several new therapies have been developed such as new XDH inhibitors urate transporter (URAT) 1 inhibitor, and a modified recombinant uricase. The dosage reduction of the new XDH inhibitors, febuxostat and FYX-051, is not necessary in patients with renal insufficiency because renal excretion is not main excretory pathway. JTT-552 is a first medicine targeting on URAT1. Polyethylene glycol (PEG) conjugation with recombinant uricase sufficiently reduces the immunogenicity to permit repeated dosing and the clinical trials are ongoing for patients with treatment-failure gout and hyperuricemia.
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PMID:[New antihyperuricemic medicine: febuxostat, Puricase, etc]. 1840 28

This report is the story of the long journey to identify the mechanism of fulminant hepatitis by the antigout drug, Benzbromarone. As soon as the 8th gout patient prescribed Benzbromarone (Benz) died of fulminant hepatitis in 20 years, the letter was sent to doctors identifying it as the causative agent in February 2000. At that time, Benz had been prescribed to 350,000 patients/year for 20 years. Is Benz the real cause of fulminant hepatitis? 1. Benz is a PPARa agonist like fenofibrate, and not a PPARgamma like troglitazone. 2. Troglitazone and Allopurinol have shown apoptosis in a human primary hepatocyte culture with the DNA laddering method, but Benz has not. 3. It was reported in 1979 that benzarone is a metabolite dissociated from two Br bases of Benz, but Walter et al. reported in 1987 that the Br base was not dissociated. Benzarone was not produced by an in vitro study with human S-9 and by an in vivo clinical study of Japanese volunteers. 4. The main metabolite of Benz in humans is 6-OH Benz, which has URAT-1 activity, like Benz. 5. It has been newly discovered that CYP2C9 is only one hepatic metabolism enzyme of Benz. 6. The rate of poor metabolizers of CYP2C9*3 (homozygous) in Japan is 1/2500, meanwhile, the rate of fulminant hepatitis at this time is 8 patients in 20 years, with 350,000 patients/year; therefore, it is difficult to view poor metabolizers as the cause. 7. Hepatic injury by Benz is an idiosyncrasy, the same as with many other drugs.
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PMID:[Drug-induced hepatic injury, the challenge for cause investigation]. 2233 14