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

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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.

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References

  1. Braun J, Brandt J, Listing J, Zink A, Alten R, Burmester G, Golder W, Gromnica-Ihle E, Kellner H, Schneider M, Sorensen H, Zeidler H, Reddig J, Sieper J (2003) Long-term efficacy and safety of infliximab in the treatment of ankylosing spondylitis: an open, observational, extension study of a three-month, randomized, placebo-controlled trial. Arthritis Rheum 48(8):2224–2233 (Aug)

    Article  PubMed  CAS  Google Scholar 

  2. Temekonidis TI, Alamanos Y, Nikas SN, Bougias DV, Georgiadis AN, Voulgari PV et al (2003) Infliximab therapy in patients with ankylosing spondylitis: an open label 12 month study. Ann Rheum Dis 62(12):1218–1220 (Dec)

    Article  PubMed  CAS  Google Scholar 

  3. Davis JC Jr, Van Der Heijde D, Braun J, Dougados M, Cush J, Clegg DO et al (2003) Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 48(11):3230–3236 (Nov)

    Article  PubMed  CAS  Google Scholar 

  4. Gorman JD, Sack KE, Davis JC Jr (2002) Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med 346(18):1349–1356 (May 2)

    Article  PubMed  CAS  Google Scholar 

  5. Baumgartner SW, Fleischmann RM, Moreland LW, Schiff MH, Markenson J, Whitmore JB (2004) Etanercept (Enbrel) in patients with rheumatoid arthritis with recent onset versus established disease: improvement in disability. J Rheumatol 31(8):1532–1537 (Aug)

    PubMed  CAS  Google Scholar 

  6. Peterson JR, Hsu FC, Simkin PA, Wener MH (2003) Effect of tumour necrosis factor alpha antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis 62(11):1078–1082 (Nov)

    Article  PubMed  CAS  Google Scholar 

  7. Michel M, Duvoux C, Hezode C, Cherqui D (2003) Fulminant hepatitis after infliximab in a patient with hepatitis B virus treated for an adult onset Still’s disease. J Rheumatol 30(7):1624–1625 (Jul)

    PubMed  Google Scholar 

  8. Tilg H, Jalan R, Kaser A, Davies NA, Offner FA, Hodges SJ et al (2003) Anti-tumor necrosis factor-alpha monoclonal antibody therapy in severe alcoholic hepatitis. J Hepatol 38(4):419–425 (Apr)

    Article  PubMed  CAS  Google Scholar 

  9. Forrest EH, Oien KA, Dickson S, Galloway D, Mills PR (2002) Improvement in cholestasis associated with total parenteral nutrition after treatment with an antibody against tumour necrosis factor alpha. Liver 22(4):317–320 Aug

    Article  PubMed  Google Scholar 

  10. Hansen KE, Hildebrand JP, Genovese MC, Cush JJ, Patel S, Cooley DA, Cohen SB, Gangnon RE, Schiff MH (2004) The efficacy of switching from etanercept to infliximab in patients with rheumatoid arthritis. J Rheumatol 31(6):1098–1102 (Jun)

    PubMed  CAS  Google Scholar 

  11. Van Vollenhoven R, Harju A, Brannemark S, Klareskog L (2003) Treatment with infliximab (Remicade) when etanercept (Enbrel) has failed or vice versa: data from the STURE registry showing that switching tumour necrosis factor alpha blockers can make sense. Ann Rheum Dis 62(12):1195–1198 (Dec)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rheumatology Unit, Hospital Virgen de la Salud, Toledo, Spain

    Angel M. García Aparicio, José Rey Rey, Azucena Hernández Sanz & Juana Sampedro Alvarez

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  1. Angel M. García Aparicio
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  2. José Rey Rey
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  3. Azucena Hernández Sanz
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  4. Juana Sampedro Alvarez
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Correspondence to Angel M. García Aparicio.

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García Aparicio, A.M., Rey, J.R., Sanz, A.H. et al. Successful treatment with etanercept in a patient with hepatotoxicity closely related to infliximab. Clin Rheumatol 26, 811–813 (2007). https://doi.org/10.1007/s10067-006-0253-y

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  • DOI: https://doi.org/10.1007/s10067-006-0253-y

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