From the Guidelines
Steroids are not typically associated with causing transaminitis, as they are often used to treat autoimmune hepatitis and can improve serum transaminases to normal levels. According to the study by 1, the majority of AIH patients respond well to steroid-based immunosuppressive treatment, and serum transaminases improve to levels within the normal range. However, it is essential to note that anabolic steroids, particularly C-17 alpha-alkylated steroids, can be hepatotoxic and cause transaminitis.
The risk of transaminitis with therapeutic corticosteroids like prednisone, methylprednisolone, or dexamethasone is lower, but patients on long-term treatment or high doses should have periodic liver function monitoring. If transaminitis develops, dose reduction or discontinuation may be necessary depending on the severity. The liver enzyme elevation is typically reversible once the medication is stopped or reduced.
Some key points to consider:
- Patients with pre-existing liver disease should use steroids with caution and under close medical supervision.
- The mechanism of steroid-induced transaminitis involves direct hepatocellular injury and can lead to cholestasis in some cases.
- Anabolic steroids are particularly hepatotoxic, and their use should be avoided or closely monitored.
- Therapeutic corticosteroids can improve liver function in patients with autoimmune hepatitis, as shown in the study by 1.
- The study by 1 provides guidance on managing immune-related adverse events, including transaminitis, in patients treated with immune checkpoint inhibitor therapy, and recommends considering liver biopsy and adding azathioprine or mycophenolate if infectious cause is ruled out.
Overall, while steroids are not typically associated with causing transaminitis, it is crucial to monitor liver function in patients on long-term treatment or high doses, especially those with pre-existing liver disease.
From the FDA Drug Label
Increases in alanine transaminase (ALT, SGPT), aspartate transaminase (AST, SGOT), and alkaline phosphatase have been observed following corticosteroid treatment These changes are usually small, not associated with any clinical syndrome, and reversible upon discontinuation
Steroids can cause transaminitis, as evidenced by increases in liver enzymes such as ALT and AST. However, these changes are usually small and reversible upon discontinuation of the steroid treatment 2.
From the Research
Steroids and Transaminitis
- Steroids, specifically anabolic steroids, have been shown to cause hepatotoxicity, which can manifest as elevated liver transaminases 3, 4, 5.
- The frequency and severity of side effects, including hepatotoxicity, depend on several factors such as the formulation of the drug, route of administration, dosage, duration of use, and individual sensitivity and response 3.
- Anabolic steroid users tend to take supraphysiologic doses or multiple steroids and other drugs simultaneously, which increases the risk of adverse effects, including hepatotoxicity 3.
- Hepatotoxicity caused by anabolic steroids can be seen as elevated liver transaminases, acute cholestatic syndrome, chronic vascular injury, hepatic tumors, and toxicant-associated fatty liver disease, as well as significant changes in lipoproteins 3.
- Many of these changes will stabilize or reverse with cessation of steroid use, but some can be life-threatening 3, 4.
- There is evidence to suggest that testosterone therapy may have a beneficial effect on liver disease, including reducing liver steatosis and fibrosis in men with metabolic dysfunction-associated steatotic liver disease 6.