Anti-tumour necrosis factor agent and liver injury: Literature review, recommendations for management

Roberta Elisa Rossi, Ioanna Parisi, Edward John Despott, Andrew Kenneth Burroughs, James O'Beirne, Dario Conte, Mark Ian Hamilton, Charles Daniel Murray

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)17352-17359
Number of pages8
JournalWorld Journal of Gastroenterology
Volume20
Issue number46
DOIs
Publication statusPublished - Dec 14 2014

Fingerprint

Tumor Necrosis Factor-alpha
Liver
Wounds and Injuries
Inflammatory Bowel Diseases
Transaminases
Therapeutics
Pharmaceutical Preparations
Liver Function Tests
Jaundice
Alanine Transaminase
PubMed
Hepatitis
Multivariate Analysis
Guidelines
Biopsy
Infliximab

Keywords

  • Drug-related liver injury
  • Hypertransaminasemia
  • Infiximab
  • Inflammatory bowel disease
  • Tumour necrosis factor inhibitors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rossi, R. E., Parisi, I., Despott, E. J., Burroughs, A. K., O'Beirne, J., Conte, D., ... Murray, C. D. (2014). Anti-tumour necrosis factor agent and liver injury: Literature review, recommendations for management. World Journal of Gastroenterology, 20(46), 17352-17359. https://doi.org/10.3748/wjg.v20.i46.17352

Anti-tumour necrosis factor agent and liver injury : Literature review, recommendations for management. / Rossi, Roberta Elisa; Parisi, Ioanna; Despott, Edward John; Burroughs, Andrew Kenneth; O'Beirne, James; Conte, Dario; Hamilton, Mark Ian; Murray, Charles Daniel.

In: World Journal of Gastroenterology, Vol. 20, No. 46, 14.12.2014, p. 17352-17359.

Research output: Contribution to journalArticle

Rossi, RE, Parisi, I, Despott, EJ, Burroughs, AK, O'Beirne, J, Conte, D, Hamilton, MI & Murray, CD 2014, 'Anti-tumour necrosis factor agent and liver injury: Literature review, recommendations for management', World Journal of Gastroenterology, vol. 20, no. 46, pp. 17352-17359. https://doi.org/10.3748/wjg.v20.i46.17352
Rossi, Roberta Elisa ; Parisi, Ioanna ; Despott, Edward John ; Burroughs, Andrew Kenneth ; O'Beirne, James ; Conte, Dario ; Hamilton, Mark Ian ; Murray, Charles Daniel. / Anti-tumour necrosis factor agent and liver injury : Literature review, recommendations for management. In: World Journal of Gastroenterology. 2014 ; Vol. 20, No. 46. pp. 17352-17359.
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