毒理性
在大规模的多发性硬化症患者中进行的西波尼莫德控制试验中,血清ALT升高是常见的,通常发生在治疗的前3个月内,并持续整个治疗期间。这些升高通常是轻微且无症状的,在停止治疗后3个月内恢复到基线值。在接受西波尼莫德的患者中,有6%至8%的患者转氨酶升高超过正常上限(ULN)的3倍,而安慰剂组不到2%。在这些上市前的临床试验中,没有出现急性肝炎或临床上明显的肝损伤的病例,但肝功能测试升高导致1%的患者停止治疗。因此,在治疗期间轻度至中度且短暂的血清酶升高并不少见,但由于西波尼莫德引起的临床上明显的肝损伤和黄疸尚未有报道,尽管其使用经验有限。
In large controlled trials of siponimod in patients with multiple sclerosis, serum ALT elevations were common, typically arising during the first 3 months and persisting throughout the treatment period. The elevations were generally mild and asymptomatic, and they returned to baseline values within 3 months of stopping. Aminotransferase elevations above 3 times upper limit of normal (ULN) were reported in 6% to 8% of siponimod recipients compared to less than 2% of placebo recipients. In these prelicensure clinical trials, there were no cases of acute hepatitis or clinically apparent liver injury but elevations in liver tests led to discontinuation in 1% if subjects. Thus, mild-to-moderate and transient serum enzyme elevations during therapy are not uncommon, but clinically apparent liver injury with jaundice due to siponimod has not been reported, although the clinical experience with its use has been limited.
来源:LiverTox