From the Guidelines
Patients with DCMP should avoid combination therapies of immune checkpoint inhibitors (ICIs) and other hepatotoxic medications due to the increased risk of immune-mediated liver injury. The use of combination anti-neoplastic regimens, particularly those involving two or more ICIs or an ICI with other chemotherapeutics, has been associated with a higher incidence of liver adverse events, including serum ALT elevations 1. For example, the combination of ipilimumab and nivolumab has been shown to increase the incidence of grade ≥3 serum ALT elevations to 11-18%, compared to 0-3% when used as monotherapy 1. Similarly, the combination of vemurafenib and ipilimumab has been associated with a high incidence of grade 3 ALT or AST elevations, leading to early termination of a phase I study 1. Therefore, it is crucial to carefully weigh the benefits and risks of using combination therapies in DCMP patients and to closely monitor liver function when such therapies are necessary. Key medications to avoid or use with caution in DCMP patients include:
- Combination ICIs, such as ipilimumab and nivolumab
- Vemurafenib and other BRAF inhibitors
- Dacarbazine and other chemotherapeutics with hepatotoxic potential
- Other medications with known hepatotoxicity, such as amodiaquine Regular liver function monitoring is essential when using these medications, and alternative therapies with less hepatotoxic potential should be considered when available. Patients should also be educated about the risks of liver injury and the importance of reporting any symptoms of liver dysfunction promptly.
From the Research
Hepatotoxic Drugs in DCMP Patients
There is limited information available on hepatotoxic drugs in DCMP patients from the provided studies.
- The studies primarily focus on the diagnosis, risk stratification, and treatment approaches for dilated cardiomyopathy (DCM) [ 2, 3].
- None of the studies directly address hepatotoxic drugs in DCMP patients.
- However, it can be inferred that patients with DCMP may be at risk of thromboembolic events [ 4, 5,6], and anticoagulation therapy may be considered as a treatment option.
- The use of anticoagulants, such as warfarin, aspirin, dabigatran, rivaroxaban, and apixaban, is discussed in the context of preventing thromboembolic events in DCMP patients [ 4, 6].
- It is essential to note that the provided studies do not explicitly discuss the hepatotoxicity of these drugs in DCMP patients.