Harmful effects and potential benefits of anti-tumor necrosis factor (TNF)-α on the liver

Loris Riccardo Lopetuso, Giammarco Mocci, Manuela Marzo, Francesca D’aversa, Gian Lodovico Rapaccini, Luisa Guidi, Alessandro Armuzzi, Antonio Gasbarrini, Alfredo Papa

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Article number2199
JournalInternational Journal of Molecular Sciences
Issue number8
Publication statusPublished - Aug 1 2018


  • Adalimumab
  • Alcoholic hepatitis
  • Autoimmune hepatitis
  • Certolizumab pegol
  • Drug-induced liver injury
  • Etanercept
  • Golimumab
  • Hepatitis B virus
  • Hepatitis C virus
  • Infliximab
  • Non-alcoholic fatty liver disease

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry


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