Hepatotoxicity of the thiazolidinediones

Troglitazone, the first of the thiazolidinediones, caused severe hepatotoxicity including liver failure in several patients. It appears, however, that the thiazolidinediones as a class are not as hepatotoxic as troglitazone. Comparative data at comparable dates of usage indicate that pioglitazone and rosiglitazone are not significant hepatotoxins. This is further supported by experimental data that demonstrate that troglitazone, alone among the thiazolidinediones, is toxic in hepatocyte cell culture. All of the thiazolidinediones cause ALT elevations; however, ALT monitoring for hepatotoxicity does not appear to prevent serious liver disease nor reduce patient risk.