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Re: Liver Enzyme Article (Wash. Post) » Larry Hoover

Posted by saturn on May 12, 2006, at 7:32:14

In reply to Re: Liver Enzyme Article (Wash. Post) » saturn, posted by Larry Hoover on May 11, 2006, at 13:20:26


> I have a problem with the conclusion reached. The differential would require exclusion of virally mediated outcomes. But, upon excluding those, I think there are other explanations not yet excluded. How did they conclude that it was an autoimmune hepatitis, let alone that it was drug-induced? It's a plausible diagnosis, but I don't feel that alone is enough.

Even *if* it was a drug-induced AIH, it doesn't follow that being a poor metabolizer contributed to it. While rare, I believe AIH may often occur at standard therapeutic concentrations. (though I'm admittedly ignorant on this, I believe AIH involves a phenomenon called 'molecular mimicry', though I may be mistaken).

I don't mean to totally disregard this possibility, but I think they were reaching in their conclusions, at least as stated, in the effort to promote CYP genotyping. And I'm all for this genotyping as well--I've ordered a 2D6 analysis. I'd like to have a more thorough CYP analysis but I'm breaking the bank with the 2D6 alone. Because I've ended up in the ER on more than one occasion a few days after starting 2D6 drugs, I have a reasonable index of suspicion for doing so--so in my case I'm looking at it as a lifelong and possibly lifesaving investment I'm willing to make.


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poster:saturn thread:642166
URL: http://www.dr-bob.org/babble/20060510/msgs/642924.html