New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease

Shelton, Edward; Chaudrey, Khadija; Sauk, Jenny; Khalili, Hamed; Masia, Ricard; Nguyen, Deanna D.; Yajnik, Vijay; Ananthakrishnan, Ashwin N.

doi:10.1111/apt.13159

Cited by 55 publications

(67 citation statements)

References 32 publications

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“…Overall, 48 cases were considered due to anti-TNF-α medications. The majority displayed autoimmune characteristics with positive serological markers [94]. …”

Section: Anti-tnf-α Liver Toxicitymentioning

confidence: 99%

Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver

Lopetuso

Mocci

Marzo

et al. 2018

IJMS

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Anti-tumor necrosis factor (TNF)-α agents represent an effective treatment for chronic inflammatory diseases. However, some concerns about their potentially undesirable effects on liver function have been reported. On the other hand, evidence of their therapeutic effects on certain liver diseases is accumulating. Many data showed the safety of anti-TNF-α in patients with chronic hepatitis B and C and in liver transplanted patients even if a strict follow-up and prophylaxis are recommended in well-defined subgroups. On the other side, anti-TNF-α-induced liver injury is not a rare event. However, it is often reversible after anti-TNF-α withdrawal. Anti-TNF-α agents have been tested in advanced stages of severe alcoholic hepatitis and non-alcoholic fatty liver disease. Limited data on the efficacy of anti-TNF-α in patients with autoimmune hepatitis and primary biliary cholangitis are also available. In this review, we explored the hepatic safety concerns in patients receiving anti-TNF-α agents with and without pre-existent hepatic diseases. In addition, the available evidence on their potential benefits in the treatment of specific hepatic diseases is discussed.

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“…Overall, 48 cases were considered due to anti-TNF-α medications. The majority displayed autoimmune characteristics with positive serological markers [94]. …”

Section: Anti-tnf-α Liver Toxicitymentioning

confidence: 99%

Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver

Lopetuso

Mocci

Marzo

et al. 2018

IJMS

View full text Add to dashboard Cite

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“…As the indications for the anti-TNF-α class of medications expanded and usage became more widespread, case series were collected, further providing evidence that there was an association between TNF-α antagonists and liver injury [26]. Over the past few years, several larger studies—including queries of large databases of patients on anti-TNF-α therapy and liver injury networks—have been published, and these have helped to better characterize the liver injury patterns that are encountered [8, 27–29]. …”

Section: Reported Adverse Effects: Focus On Dilimentioning

confidence: 99%

“…In the majority (8/11) of the cases, the authors felt it was highly probable that the liver injury was due to the anti-TNF-α medications [27]. Similarly, a recent paper by Shelton et al [29] reported a retrospective cohort review of patients from two large academic medical centres and their affiliated clinics. These authors found 102 cases of elevated serum alanine aminotransferase levels in patients with inflammatory bowel disease on anti-TNF-α therapy, of which 48 were felt to be due to anti-TNF-α therapy, based on RUCAM analysis (Table 2) [29].…”

Section: Reported Adverse Effects: Focus On Dilimentioning

confidence: 99%

“…When the studies by Ghabril et al [8], Björnsson et al [27] and Shelton et al [29] are compared, there are some notable differences, including (inter alia) the definition of liver injury and the patient populations studied (Fig. 1a).…”

Section: Reported Adverse Effects: Focus On Dilimentioning

confidence: 99%

“…However, there also are several prominent similarities that allow for a better understanding of the nature of the liver injury caused by anti-TNF-α medications. First, it appears that the anti-TNF-α medication that most commonly causes liver injury is infliximab [8, 27, 29], whereas etanercept and adalimumab have been implicated to much lesser degrees (Fig. 1a) [8, 27, 29].…”

Section: Reported Adverse Effects: Focus On Dilimentioning

confidence: 99%

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Hepatotoxicity Associated with the Use of Anti-TNF-α Agents

et al. 2015

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Medications to inhibit the actions of tumour necrosis factor alpha have revolutionized the treatment of several pro-inflammatory autoimmune conditions. Despite their many benefits, several serious side effects exist and adverse reactions do occur from these medications. While many of the medications’ potential adverse effects were anticipated and recognized in clinical trials prior to drug approval, several more rare adverse reactions were recorded in the literature as the popularity, availability and distribution of these medications grew. Of these potential adverse reactions, liver injury, although uncommon, has been observed in some patients. As case reports accrued over time and ultimately case series developed, the link became better established between this family of medicines and various patterns of liver injury. Interestingly, it appears that the majority of cases exhibit an autoimmune hepatitis profile both in serological markers of autoimmune liver disease and in classic autoimmune features seen on hepatic histopathology. Despite the growing evidence of this relationship, the pathogenesis of this reaction remains incompletely understood, but it appears to depend on characteristics of the medications and the genetic composition of the patients; it is likely more complicated than a simple medication class effect. Because of this still incomplete understanding and the infrequency of the occurrence, treatments have also been limited, although it is clear that most patients improve with cessation of the offending agent and, in certain cases, glucocorticoid use. However, more needs to be done in the future to unveil the underlying mechanisms of this adverse reaction.

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Study of Biologics and Biosimilars

Curtis

2019

Pharmacoepidemiology

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New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease

Abstract: SUMMARY BackgroundAnti-tumour necrosis factor a (anti-TNF) agents have been implicated in drug-induced liver injury. There is minimal data on this occurrence in inflammatory bowel disease (IBD) patients.

Cited by 55 publications

References 32 publications

Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver

Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver

Hepatotoxicity Associated with the Use of Anti-TNF-α Agents

Study of Biologics and Biosimilars

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