Ustekinumab-induced autoimmune hepatitis: about a case report

Abstract

Ustekinumab is a fully human monoclonal antibody that binds to interleukin (IL)-12/23. Ustekinumab-related liver injury (UST) is rare. There is limited data available on the potential for ustekinumab-liver interaction. We report the case of a patient from our institution followed for colitis ulcerative who developed autoimmune hepatitis (AIH) during treatment with ustekinumab. The diagnosis of autoimmune hepatitis was retained on the simplified criteria for autoimmune hepatitis. Therapeutic management consisted of stopping ustekinumab and starting corticosteroids and immunosuppressants, with regression of cytolysis at 2 months. The purpose of the article is to alert readers and encourage them to report similar cases for better knowledge of the drug.

Inflammatory Bowel Disease Therapies and Acute Liver Injury

“…Ustekinumab was described as safe from a hepatic perspective according to phase III and IV studies and PHOENIX I and II studies. To date, rare cases of autoimmune hepatitis induced by this drug have been detected, but the mechanisms by which Ustekinumab causes this type of adverse effect are not yet known [ 78 ].…”

Hepatotoxicity in inflammatory bowel disease: Immunomodulators, biologics, and beyond

“…[42] In another case, ustekinumab was suspected to have induced autoimmune-like hepatitis. [43] However, the patient had a relapse of autoimmune hepatitis (AIH) after normalization of liver tests and cessation of vedolizumab treatment. Thus, the relationship between the use vedolizumab and the development of AIH is unclear and might be a coincidence.…”

“…The drug was marketed in 2009 and has since then been extensively used in the treatment of IBD and psoriasis. Despite this, to our best knowledge, only 2 cases of DILI were described in the literature 42,43 . A patient developed hepatocellular injury without jaundice after the first dose of ustekinumab for the treatment of psoriasis 42 .…”

“…Despite this, to our best knowledge, only 2 cases of DILI were described in the literature. [42,43] A patient developed hepatocellular injury without jaundice after the first dose of ustekinumab for the treatment of psoriasis. [42] The transaminases lowered markedly in the following days and eventually normalized without any treatment.…”

“…Other specific causes of liver injury were excluded, except for hepatitis E, but the liver biopsy was more compatible with DILI than viral hepatitis 42 . In another case, ustekinumab was suspected to have induced autoimmune-like hepatitis 43 …”