{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T21:07:01Z","timestamp":1776892021977,"version":"3.51.2"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>A 33\u2010year\u2010old man was referred with hyperosmotic symptoms of 4\u2009weeks. Clinical examination showed palpable hepatomegaly and no stigmata of liver disease. Findings were random glucose 16.6\u2009mmol\/L, HbA1c 12.4%, triglyceride 6.2\u2009mmol\/L, normal LFTs and ultrasound liver: increased echogenicity. Management consisted of dietician referral and commencement of metformin 500\u2009mg bd, diamicron MR 60\u2009mg od, and fenofibrate 145\u2009mg od. He was non\u2010compliant, complaining of \u201cheaviness of head\u201d after consuming oral diabetic agents, without symptoms of hypoglycemia. Treatment was switched to Kombiglyze XR (saxaglipitin 5\u2009mg\u2009+\u2009metformin 1000\u2009mg) and empagliflozin 25\u2009mg od. He presented 1\u2009week later with generalised pruritus with ALT 307\u2009IU\/L and serum GGT 808\u2009IU\/L. Following this, a percutaneous liver biopsy was performed, revealing steatohepatitis and marked intra\u2010hepatic cholestasis. Kombiglyze XR was withheld, with resolution of LFTs to baseline. Phenotypes of liver injury are categorised according to R value, defined as ratio ALT\/ULN:ALP\/ULN. R value of \u22655:hepatocellular injury, \u22642:cholestatic injury, 2\u20135:mixed\u2010type injury. Here, R value points toward mixed type (R\u2009=\u20093.203). Hepatotoxicity in patients with NASH is difficult to diagnose, based on laboratory parameters. Liver histology was useful in indicating additional changes apart from NASH, causing liver derangement. The Rousal Uclaf Causality Assessment Method is a scoring method to determine the probability of drug induced liver injury. RUCAM score for this case was 6 (probable adverse drug reaction). Hepatotoxicity from saxagliptin not been reported prior. Clinicians need to be more vigilant, particularly in patients with NASH.<\/jats:p>","DOI":"10.1002\/jgh3.12083","type":"journal-article","created":{"date-parts":[[2018,10,2]],"date-time":"2018-10-02T02:09:06Z","timestamp":1538446146000},"page":"242-245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Kombiglyze (metformin and saxagliptin)\u2010induced hepatotoxicity in a patient with non\u2010alcoholic fatty liver disease"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2355-4236","authenticated-orcid":false,"given":"Abdul Malik","family":"Thalha","sequence":"first","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine University Malaya Medical Centre  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5824-0590","authenticated-orcid":false,"given":"Sanjiv","family":"Mahadeva","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine University Malaya Medical Centre  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander Tong","family":"Boon Tan","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Internal Medicine University Malaya Medical Centre  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kein Seong","family":"Mun","sequence":"additional","affiliation":[{"name":"Department of Pathology University Malaya  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-2247"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1872-034X.2012.01031.x"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/11532980-000000000-00000"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12267"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27157"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/2193-1801-3-14"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.06.033"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/11534750-000000000-00000"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(13)70084-6"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12185"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2105"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.2014.966078"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90101-6"},{"key":"e_1_2_4_15_1","doi-asserted-by":"crossref","DOI":"10.1111\/j.1463-1326.2012.01610.x","article-title":"Longer term safety of dipeptidyl peptidase\u20104 inhibitors in patients with type 2 diabetes mellitus: systematic review and meta\u2010analysis","volume":"14","author":"Goo\u00dfen K","year":"2012","journal-title":"Diabetes Obes. 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