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Anti-tumour necrosis factor agent and liver injury: literature review, recommendations for management.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2014 Dec 14; Vol. 20 (46), pp. 17352-9. - Publication Year :
- 2014
-
Abstract
- Abnormalities in liver function tests, including transient and self-limiting hypertransaminasemia, cholestatic disease and hepatitis, can develop during treatment with anti-tumour-necrosis-factor (TNF) therapy. The optimal management of liver injury related to anti-TNF therapy is still a matter of debate. Although some authors recommend discontinuing treatment in case of both a rise of alanine aminotransferase more than 5 times the upper limit of normal, or the occurrence of jaundice, there are no standard guidelines for the management of anti-TNF-related liver injury. Bibliographical searches were performed in PubMed, using the following key words: inflammatory bowel disease (IBD); TNF inhibitors; hypertransaminasemia; drug-related liver injury; infliximab. According to published data, elevation of transaminases in patients with IBD treated with anti-TNF is a common finding, but resolution appears to be the usual outcome. Anti-TNF agents seem to be safe with a low risk of causing severe drug-related liver injury. According to our centre experience, we found that hypertransaminasemia was a common, mainly self-limiting finding in our IBD cohort and was not correlated to infliximab treatment on both univariate and multivariate analyses. An algorithm for the management of liver impairment occurring during anti-TNF treatment is also proposed and this highlights the need of a multidisciplinary approach and suggests liver biopsy as a key-point in the management decision in case of severe rise of transaminases. However, hepatic injury is generally self-limiting and drug withdrawal seems to be an exception.
- Subjects :
- Algorithms
Animals
Chemical and Drug Induced Liver Injury diagnosis
Chemical and Drug Induced Liver Injury immunology
Chemical and Drug Induced Liver Injury metabolism
Chemical and Drug Induced Liver Injury therapy
Critical Pathways
Humans
Liver immunology
Liver metabolism
Liver Function Tests
Practice Guidelines as Topic
Predictive Value of Tests
Risk Assessment
Risk Factors
Tumor Necrosis Factor-alpha immunology
Tumor Necrosis Factor-alpha metabolism
Anti-Inflammatory Agents adverse effects
Biological Products adverse effects
Chemical and Drug Induced Liver Injury etiology
Liver drug effects
Tumor Necrosis Factor-alpha antagonists & inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 20
- Issue :
- 46
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 25516646
- Full Text :
- https://doi.org/10.3748/wjg.v20.i46.17352