Infliximab-induced acute hepatitis during Crohn's disease therapy: Absence of cross-toxicity with adalimumab

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

“…In our study, we found that patients could safely be transitioned to a second anti-TNF following liver enzyme elevation and cross-reactivity has not previously been described 17,20 with the development of hepatotoxicity likely being specific to the particular anti-TNF agent rather than a class effect. Indeed, we did not see recurrence in the 10 patients who switched to an alternative anti-TNF.…”

“…Infliximab and adalimumab have been implicated in DILI in case reports and small case series predominantly in patients with rheumatological disorders. 10,[12][13][14][15][16][17][18][19][20][21] A population-based study from Iceland implicated infliximab as the most likely anti-TNF to cause DILI at a rate of 1 in 120, but included only 11 patients with liver injury. 22 The largest published series of 34 patients with 6 unique patients and 28 from the literature included only 12 patients with IBD, 11 due to infliximab and 1 related to adalimumab.…”

Infliximab-Induced Autoimmune Hepatitis with Successful Switch to Adalimumab in a Patient with Crohn’s disease: The Index Case

“…The chronological evolution of the illness with respect to infliximab administration, the positive serologic data (anti-nuclear antibodies and elevated gamma globulin) and demonstration of autoimmune histopathologic features including interface hepatitis and abundant plasma cells on liver biopsy provide substantial evidence of an unusual autoimmune type of drug hepatotoxicity. One previous report of a patient with Crohn's disease and infliximab hepatotoxicity also showed a successful switch to adalimumab [5]. However, the case described had no specific biopsy features of autoimmune hepatitis nor the specific generation of autoantibodies as described in our present report.…”

Risk of Drug-Induced Liver Injury From Tumor Necrosis Factor Antagonists

“…Infliximab has been shown to be the most commonly implicated agent. [1][2][3][4][5][6][7][8][9][10][11][12][13] In the series by Ghabril et al, 13 overall 76% of cases reported were associated with infliximab. In the current study only 1 case each of adalimumab and etanercept were detected, however, because the numbers were small it was very difficult to ascertain the absolute risk of liver injury associated with these 2 drugs.…”

“…22 With this in mind it does not seem indicated to start azathioprine together with corticosteroids, as used by many of the investigators in case reports. [1][2][3][4][5][6][7][8][9][10][11][12] Interestingly, although neither ANA positivity, the underlying disease activity, or dose of the TNF-a antagonists was different in the DILI patients vs in the control group, the use of DMARDs, particularly methotrexate, was significantly more common in the controls who did not develop liver injury. The reason for this is not clear.…”