داء ويلسون في المرضى عديمي الأعراض عندما لا يبلغ علاج الخط الأول بالزنك أو خلب المعادن الهدف المطلوب

References

1. Either zinc or chelators may be used in asymptomatic patients without signs of significant liver involvement (LoE 4, weak recommendation, consensus).
2. In patients with WD who do not achieve sufficient treatment response on first-line therapy despite a good adherence to treatment and a 24-h urinary copper excretion in the target range, or side effects, switching treatment should be considered (D-penicillamine to trientine and vice versa or zinc to chelators) (LoE 2, strong recommendation, strong consensus).
3. 24-h urinary copper excretion: 200–500 µg (3–8 µmol)/24 h on maintenance treatment.