https://doi.org/10.4081/reumatismo.2024.1732
Assessment of liver and kidney function in patients with ankylosing spondylitis on long-term non-steroidal anti-inflammatory drug therapy
Submitted: 28 March 2024
Accepted: 5 May 2024
Published: 24 September 2024
Accepted: 5 May 2024
Abstract Views: 38
PDF: 29
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. This study aimed to analyze the status of liver [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and kidney (serum creatine) function in ankylosing spondylitis (AS) patients assuming continuously non-steroidal anti-inflammatory drugs (NSAIDs) alone over a long period.
Methods. Between 2013 and 2022, there were records of 385 AS patients. Of them, 56 were receiving only NSAIDs, and the files of these patients were retrospectively analyzed. Demographic and clinical characteristics were collected. Blood tests, including serum creatinine, AST, and ALT, were assessed at each visit.
Results. Of the 56 patients, 39 were male. The mean age was 45.30 years, and the follow-up period was 9.80 years. Of them, 44.6% used indomethacin, 26.8% naproxen, 17.9% diclofenac, 5.4% acemethazine, 3.6% meloxicam, and 1.8% celecoxib. The mean baseline serum creatinine was 0.71 mg/dL. The mean baseline serum AST and ALT were 19.6 u/L and 22.9 u/L, respectively. Baseline creatinine, AST, and ALT were not statistically significantly different between sexes. There was a statistically significant difference between mean creatinine concentrations at baseline and at year 3. One patient on naproxen discontinued treatment due to elevated creatinine. The creatinine level decreased during the patient's follow-up. Liver enzymes above 3 times the normal value were not seen in any patient.
Conclusions. Based on real-world data, long-term use of NSAIDs has generally not led to acute liver and kidney injury or progressive impairment of hepatorenal function requiring discontinuation of treatment.
Van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978-91.
DOI: https://doi.org/10.1136/annrheumdis-2016-210770
Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82: 19-34.
DOI: https://doi.org/10.1136/ard-2022-223296
Lories RJ, Luyten FP, de Vlam K. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis. Arthritis Res Ther 2009; 11: 221.
DOI: https://doi.org/10.1186/ar2642
Poddubnyy D, van der Heijde D. Therapeutic controversies in spondyloarthritis: nonsteroidal anti-inflammatory drugs. Rheum Dis Clin North Am 2012; 38: 601-11.
DOI: https://doi.org/10.1016/j.rdc.2012.08.005
Donati M, Conforti A, Lenti MC, Capuano A, Bortolami O, Motola D, et al. Risk of acute and serious liver injury associated to nimesulide and other NSAIDs: data from drug-induced liver injury case-control study in Italy. Br J Clin Pharmacol 2016; 82: 238-48.
DOI: https://doi.org/10.1111/bcp.12938
Trukhan DI. Nonsteroidal anti-inflammatory drugs during the provision of primary health care through the prism drug safety and comorbidity: in focus aceclofenac. Cons Medicum 2017; 19: 75-83.
DOI: https://doi.org/10.26442/2075-1753_19.8.75-83
Harty T, O'Shaughnessy M, Harney S. Therapeutics in rheumatology and the kidney. Rheumatology 2023; 62: 1009-20.
DOI: https://doi.org/10.1093/rheumatology/keac460
Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective. Biochem Pharmacol 2020; 180: 114147.
DOI: https://doi.org/10.1016/j.bcp.2020.114147
Teoh NC, Chitturi S, Farrell GC. Liver disease caused by drugs. In: Feldman M, Friedman LS, Brandt LJ editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia: Elsevier, 2010; 1413-31.
DOI: https://doi.org/10.1016/B978-1-4160-6189-2.00086-X
Bessone F. Non-steroidal anti-inflammatory drugs: what is the actual risk of liver damage? World J Gastroenterol 2010; 16: 5651-61.
DOI: https://doi.org/10.3748/wjg.v16.i45.5651
Sriuttha P, Sirichanchuen B, Permsuwan U. Hepatotoxicity of nonsteroidal anti-inflammatory drugs: a systematic review of randomized controlled trials. Int J Hepatol 2018; 2018: 5253623.
DOI: https://doi.org/10.1155/2018/5253623
Zoubek ME, Lucena MI, Andrade RJ, Stephens C. Systematic review: ibuprofen-induced liver injury. Aliment Pharmacol Ther 2020; 51: 603-11.
DOI: https://doi.org/10.1111/apt.15645
Levy AR, Szabo SM, Rao SR, Cifaldi M, Maksymowych WP. Estimating the occurrence of renal complications among persons with ankylosing spondylitis. Arthritis Care Res 2014; 66: 440-5.
DOI: https://doi.org/10.1002/acr.22176
Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M, et al. NSAID use and progression of chronic kidney disease. Am J Med 2007; 120: 280.e1-7.
DOI: https://doi.org/10.1016/j.amjmed.2006.02.015
Nelson DA, Marks ES, Deuster PA, O'Connor FG, Kurina LM. Association of nonsteroidal anti-inflammatory drug prescriptions with kidney disease among active young and middle-aged adults. JAMA Netw Open 2019; 2: e187896.
DOI: https://doi.org/10.1001/jamanetworkopen.2018.7896
Koo BS, Hwang S, Park SY, Shin JH, Kim TH. The relationship between long-term use of nonsteroidal anti-inflammatory drugs and kidney function in patients with ankylosing spondylitis. J Rheum Dis 2023; 30: 126-32.
DOI: https://doi.org/10.4078/jrd.2023.0006
Kristensen LE, Jakobsen AK, Askling J, Nilsson F, Jacobsson LT. Safety of etoricoxib, celecoxib, and nonselective nonsteroidal antiinflammatory drugs in ankylosing spondylitis and other spondyloarthritis patients: a Swedish national population-based cohort study. Arthritis Care Res 2015; 67: 1137-49.
DOI: https://doi.org/10.1002/acr.22555
Obeid S, Libby P, Husni E, Wang Q, Wisniewski LM, Davey DA, et al. Cardiorenal risk of celecoxib compared with naproxen or ibuprofen in arthritis patients: insights from the PRECISION trial. Eur Heart J Cardiovasc Pharmacother 2022; 8: 611-21.
DOI: https://doi.org/10.1093/ehjcvp/pvac015
Zochling J, Bohl-Bühler MH, Baraliakos X, Feldtkeller E, Braun J. Nonsteroidal anti-inflammatory drug use in ankylosing spondylitis--a population-based survey. Clin Rheumatol 2006; 25: 794-800.
DOI: https://doi.org/10.1007/s10067-005-0132-y
Tujios S, Fontana RJ. Mechanisms of drug-induced liver injury: from bedside to bench. Nat Rev Gastroenterol Hepatol 2011; 8: 202-11.
DOI: https://doi.org/10.1038/nrgastro.2011.22
Unzueta A, Vargas HE. Nonsteroidal anti-inflammatory drug-induced hepatoxicity. Clin Liver Dis 2013; 17: 643-56.
DOI: https://doi.org/10.1016/j.cld.2013.07.009
Gebreselassie A, Aduli F, Howell CD. Rheumatologic diseases and the liver. Clin Liver Dis 2019; 23: 247-61.
DOI: https://doi.org/10.1016/j.cld.2018.12.007
García Rodríguez LA, Williams R, Derby LE, Dean AD, Jick H. Acute liver injury associated with nonsteroidal anti-inflammatory drugs and the role of risk factors. Arch Intern Med 1994; 154: 311-6.
DOI: https://doi.org/10.1001/archinte.154.3.311
Banks AT, Zimmerman HJ, Ishak KG, Harter JG. Diclofenac-associated hepatotoxicity: analysis of 180 cases reported to the Food and Drug Administration as adverse reactions. Hepatology 1995; 22: 820-7.
DOI: https://doi.org/10.1002/hep.1840220320
Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E initiative. Ann Rheum Dis 2009; 68: 1086-93.
DOI: https://doi.org/10.1136/ard.2008.094474
Laine L, Goldkind L, Curtis SP, Connors LG, Yanqiong Z, Cannon CP. How common is diclofenac-associated liver injury? Analysis of 17,289 arthritis patients in a long-term prospective clinical trial. Am J Gastroenterol 2009; 104: 356-62.
DOI: https://doi.org/10.1038/ajg.2008.149
How to Cite
Sülükcü, S., & Uslu, S. (2024). Assessment of liver and kidney function in patients with ankylosing spondylitis on long-term non-steroidal anti-inflammatory drug therapy. Reumatismo. https://doi.org/10.4081/reumatismo.2024.1732
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.