Serious liver disease induced by infliximab

Abstract

Infliximab, a chimeric monoclonal antibody that binds the tumor necrosis factor alpha (TNFalpha), is used in the treatment of rheumatoid arthritis (RA) and Crohn's disease (CD). Previous cases of significant secondary liver disease associated with infliximab treatment have been reported in patients with RA, CD, and psoriatic arthritis. Two additional patients with RA who developed a serious liver disease associated with infliximab treatment are reported here. A 39-year old RA patient was admitted with cholestatic liver disease after 8 months of treatment with infliximab. She had no history of hepatic diseases, exposure to hepatotoxic or illicit drugs, or alcohol abuse. A liver biopsy showed severe ductal proliferation with collapse and enucleation of the hepatocytes. Despite aggressive treatment with oral prednisolone, she developed hepatic failure. On the 45th day, a liver transplant was performed. The second patient, a 54-year old RA patient, was diagnosed with autoimmune hepatitis after 12 infliximab infusions. She fulfilled autoimmune hepatitis type 1 criteria. A liver biopsy disclosed an altered lobulillar structure with chronic inflammation and the formation of collagen bands. She was treated with prednisolone and azatioprine and a complete recovery was noted 1 month later. These cases should alert rheumatologists to the possibility of new adverse reactions (liver injury) associated with the use of TNFalpha blockers in an autoimmune setting.

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

“…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.…”

Fulminant hepatic failure necessitating transplantation following the initiation of infliximab therapy: a cautionary tale times two

“…However, it is known to be hepatotoxic [3][4][5][6]. While the appreciation of IFX-associated liver disease is increasing, only one other documented case of IFX-related liver failure has been reported [7]. We herein report two patients with fulminant hepatic failure temporally linked to initiation of IFX, which likely precipitated a need for urgent liver transplantation.…”

Acute Brucella melitensis M16 infection model in mice treated with tumor necrosis factor-alpha inhibitors

“…There are conflicting data about the hepatic effects of anti-TNFα drugs. In some patients, hepatotoxicity can develop due to IFX administration [32]. When the treatment was changed with ETN or ADA, hepatotoxicity disappeared in some patients who received IFX previously [33,34].…”