Successful treatment with etanercept in a patient with hepatotoxicity closely related to infliximab

Abstract

To date, hepatotoxicity with anti-TNF therapy has been associated with concomitant liver-toxicity drugs, infection or malignant diseases. We report the case of one patient with spondyloarthropathty who presented severe liver dysfunction related to infliximab. After the second infusion serum controls showed an slightly increase of transaminases. Before the administration of fifth infusion, infliximab therapy was stopped due to severe liver damage (AST 327 mU/ml, ALT 656 mU/mL, GGT 140 mU/mL, alkaline phosphate 227 mU/mL). Ten weeks after infliximab discontinuation serum concentrations of liver blood tests were normal but ankylosing spondylitis symptoms had relapsed. Therefore, he was treated with etanercept with a rapid and sustained improvement. Serum concentrations of albumin, AST, ALT, GGT and alkaline phosphate were followed and did not change for five months.

Liver Injury Secondary to Anti-TNF-Alpha Therapy in Inflammatory Bowel Disease: A Case Series and Review of the Literature

“…The lack of cross-reactivity between the TNF- α -antagonist-related liver injury, as seen in multiple case reports [2, 4, 14, 15, 18, 19, 24, 25], is likely due to the difference in molecular structure of these agents. Since infliximab is a chimeric IgG1 monoclonal antibody and adalimumab is a fully humanized IgG1 monoclonal antibody and etanercept is a fusion of recombinant soluble TNF-a receptor type 2 with an Fc domain of human IgG1, antibody formation and immune-mediated reactions are more likely to develop against infliximab rather than the latter two molecules.…”

Liver Injury From Tumor Necrosis Factor-α Antagonists: Analysis of Thirty-four Cases

“…5,6 However, it has been shown that several TNF- α antagonists have a similar ability to elicit the development of serologic markers of autoimmunity. These compounds have also been associated with reactivation of latent tuberculosis, hepatitis B, the development of lymphoma, demyelinating disease, seizures, aplastic anemia, and skin rash.…”

Recurrent hepatotoxicity associated with etanercept and adalimumab but not with infliximab in a patient with rheumatoid arthritis

“…Previous published cases suggest absence of hepatic crosstoxicity between infliximab and etanercept (8,9), and between adalimumab and etanercept (7). This has been explained because these drugs are structurally different: etanercept is a soluble TNFreceptor fusion protein, and infliximab and adalimumab are chimeric IgG1 anti-TNF-a monoclonal antibodies and by the fact that polymorphisms have been identified in genes encoding proteins related to TNF-a (1,6).…”