Arthritis treatment may cause liver injury, study says

WASHINGTON — Flavocoxid — an arthritis treatment marketed as an effective counter to joint inflammation — appears to cause “clinically significant liver injury” in some patients, and physicians should probably discourage their patients from taking it, says a new study and its accompanying editorial.

Drawing on the records of 877 patients followed by the national Drug-Induced Liver Injury Network, researchers publishing in the Annals of Internal Medicine cite three cases in which flavocoxid use was found to be the “very likely” cause of acute liver injury, and a fourth in which liver injury was found to be “possibly due to” flavocoxid use.

All four patients recovered their full liver function after discontinuing use of flavocoxid.

What could go wrong with a product that promises to tamp down inflammation with ingredients found in such foods as soy, cauliflower, kale, peanuts, apples, cocoa and green tea? At the same time, flavocoxid sounds like a regulated pharmaceutical product – it’s even got a “marketing name” – Limbrel – that sounds a lot like a drug that is widely prescribed for rheumatoid arthritis. Flavocoxid is even listed on several reputable prescription-drug sites.

So of course this “medical food product” has won the FDA’s blessing for safety and effectiveness, right? And it’s subject to the usual safety monitoring once it is approved for marketing to a wide population of patients, right?

Wrong on both counts.

Flavocoxid is “an interesting therapeutic alternative to non-steroidal anti-inflammatory drugs,” write Drs. Stephan Reichenbach and Peter Juni of the University of Bern in Switzerland, in an editorial that accompanies the Annals study. Laboratory studies suggest that flavocoxid’s plant-based bioflavenoids inhibit two enzymes implicated in the inflammatory process, and that it may act on arthritis pain and stiffness in much the same way that medications such as ibuprofen, naproxen and celecoxib do.

And an alternative to those medications would be welcome, especially if it did not carry some of the risks that come with those non-steroidal anti-inflammatory drugs: besides risking gastrointestinal side effects, patients who take such NSAIDs regularly have a two- to four-times higher risk of having or dying from a heart attack or stroke, Juni found in a recent study.

But because flavocoxid is classified as a nutritional supplement, no clinical trials demonstrating its safety and effectiveness in treating arthritis are required before it is sold: unless or until the FDA has mustered strong evidence suggesting otherwise, the product is considered safe for U.S. consumers.

Flavocoxid has been marketed to arthritis patients and their physicians since 2004. In 2009 and 2010, two clinical trials of flavocoxid become available to the public. While both favorably compared flavocoxid’s effectiveness to that of prescription naproxen, Reichenbach and Juni write that “neither trial satisfies current standards of reporting.”

The authors speculated that hypersensitivity to flavocoxid’s natural ingredients may have played a role in some of the patients’ reactions to the product. But they also noted that “unpredictable or unregulated concentrations of . polyphenolic substances” may “set the stage for toxicity.”

All of the authors of the Annals of Internal Medicine study are members of the Drug-Induced Liver Injury Network, a consortium of researchers that has been tracking patients with suspected drug-induced liver injury since 2004.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Trader Joe’s customers walk in and out of the store on Monday, Nov. 20, 2023 in Everett, Washington. (Olivia Vanni / The Herald)
New Trader Joe’s opens this week at Everett Mall

It’s a short move from a longtime location, essentially across the street, where parking was often an adventure.

Ian Bramel-Allen enters a guilty plea to second-degree murder during a plea and sentencing hearing on Wednesday, March 6, 2024, at Snohomish County Superior Court in Everett, Washington. (Ryan Berry / The Herald)
‘Deep remorse’: Man gets 17 years for friend’s fatal stabbing in Edmonds

Ian Bramel-Allen, 44, pleaded guilty Wednesday to second-degree murder for killing Bret Northcutt last year at a WinCo.

Firefighters respond to a small RV and a motorhome fire on Tuesday afternoon in Marysville. (Provided by Snohomish County Fire Distrct 22)
1 injured after RV fire, explosion near Marysville

The cause of the fire in the 11600 block of 81st Avenue NE had not been determined, fire officials said.

Ashton Dedmon appears in court during his sentencing hearing on Tuesday, March 5, 2024, at Snohomish County Superior Court in Everett, Washington. (Ryan Berry / The Herald)
Everett Navy sailor sentenced to 90 days for fatal hit and run

Ashton Dedmon crashed into Joshua Kollman and drove away. Dedmon, a petty officer on the USS Kidd, reported he had a panic attack.

A kindergarten student works on a computer at Emerson Elementary School on Wednesday, Feb. 28, 2024, in Everett, Washington. (Ryan Berry / The Herald)
‘¡Una erupción!’: Dual language programs expanding to 10 local schools

A new bill aims to support 10 new programs each year statewide. In Snohomish County, most follow a 90-10 model of Spanish and English.

Cassie Franklin, Mayor of Everett, delivers the annual state of the city address Thursday morning in the Edward D. Hansen Conference Center in Everett, Washington on March 31, 2022.  (Kevin Clark / The Herald)
At Everett mayor’s keynote speech: $35 entry, Boeing sponsorship

The city won’t make any money from the event, city spokesperson Simone Tarver said. Still, it’s part of a trend making open government advocates wary.

Logo for news use featuring the Tulalip Indian Reservation in Snohomish County, Washington. 220118
Woman drives off cliff, dies on Tulalip Reservation

The woman fell 70 to 80 feet after driving off Priest Point Drive NW on Sunday afternoon.

Everett
Boy, 4, survives fall from Everett fourth-story apartment window

The child was being treated at Seattle Children’s. The city has a limited supply of window stops for low-income residents.

People head out to the water at low tide during an unseasonably warm day on Saturday, March 16, 2024, at Lighthouse Park in Mukilteo, Washington. (Ryan Berry / The Herald)
Everett shatters record high temperature by 11 degrees

On Saturday, it hit 73 degrees, breaking the previous record of 62 set in 2007.

Snohomish County Fire District #4 and Snohomish Regional Fire & Rescue respond to a motor vehicle collision for a car and pole. The driver was pronounced dead at the scene, near Triangle Bait & Tackle in Snohomish. (Snohomish County Sheriff’s Office)
Police: Troopers tried to stop driver before deadly crash in Snohomish

The man, 31, was driving at “a high rate of speed” when he crashed into a traffic light pole and died, investigators said.

Alan Dean, who is accused of the 1993 strangulation murder of 15-year-old Bothell girl Melissa Lee, appears in court during opening statements of his trial on Monday, March 18, 2024, at Snohomish County Superior Court in Everett, Washington. (Ryan Berry / The Herald)
31 years later, trial opens in Bothell teen’s brutal killing

In April 1993, Melissa Lee’s body was found below Edgewater Creek Bridge. It would take 27 years to arrest Alan Dean in her death.

Logo for news use featuring the municipality of Snohomish in Snohomish County, Washington. 220118
Man dies after crashing into pole in Snohomish

Just before 1 a.m., the driver crashed into a traffic light pole at the intersection of 2nd Street and Maple Avenue.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.