title: Treatment of ankylosing spondylitis with TNF inhibitors does not have adverse effect on results of liver function tests: a longitudinal study.
abstract: OBJECTIVE
  To retrospectively investigate and compare the effects of tumor necrosis factor alpha inhibitors (TNFi) on hepatic enzymes in ankylosing spondylitis (AS) patients.
  
  
  METHODS
  A retrospective analysis of the records of 94 AS (66 male, 28 female) patients using TNFi was performed. Patients' clinical data, Bath Ankylosing Spondylitis Disease Activity (BASDAI) scores, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were all examined. Liver function test (LFTs) results of patients before the treatment and 3, 6 and 12 months after treatment with TNFi were investigated. Aspartate transaminase (AST) and alanine transaminase (ALT) levels were investigated as indicators of LFTs.
  
  
  RESULTS
  The TNFi drugs used were infliximab (n = 28), adalimumab (n = 32) and etanercept (n = 34). Pre-treatment values of ESR, CRP and BASDAI scores were 28.3 ± 20.1 mm/h, 1.5 ± 1.2 ng/dL and 5.2 ± 0.8, respectively. Following TNFi use there was a statistically significant decrease in disease activity score (P = 0.001). There was a significant increase in LFT at the third month evaluation compared to the initial values, while the average value was within normal range (baseline AST 19.6 ± 10.8 U/L, ALT 19.1 ± 6.4 U/L, third month AST 31.3 ± 21.6 U/L, ALT 28.1 ± 18.1 U/L, P = 0.001). Drug group comparison analysis revealed a significant difference in the adalimumab group value at the end of the first year, but no other significant difference in the data for the other months (P > 0.05). No significant correlation was determined between initial disease activity scores and LFT.
  
  
  CONCLUSIONS
  TNFi use-associated rises in hepatic enzymes were determined compared to pre-treatment but the mean values remained within normal limits. Considering the cases in the literature, in daily practice patients must be carefully monitored for liver function before treatment and at follow-up.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Division Rheumatology Farabi Hospital, Karadeniz Technical University, Medical School, Trabzon, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Capkin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Division Rheumatology Farabi Hospital, Karadeniz Technical University, Medical School, Trabzon, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Karkucak
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Karadeniz Technical University, Medical School, Trabzon, Turkey.
authors.forename: Arif M
authors.initials: AM
authors.lastname: Cosar
authors.affiliation: Igdır state Hospital, Igdır, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Ak
authors.affiliation: Mus State Hospital, Mus, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Karaca
authors.affiliation: Canakkale Onsekiz mart University, Medical School, Çanakkale, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Gokmen
authors.affiliation: Antalya State Hospital, Antalya, Turkey.
authors.forename: Bayram S
authors.initials: BS
authors.lastname: Budak
authors.affiliation: Department of Physical Medicine and Rehabilitation, Division Rheumatology Farabi Hospital, Karadeniz Technical University, Medical School, Trabzon, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tosun
mesh_terms: D000068879:Adalimumab / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000378:metabolism; D000068800:Etanercept / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000494:pharmacology / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology*; D008111:Liver Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000068879:Adalimumab; D000068800:Etanercept
keywords: TNF inhibitors; alanine transaminase; ankylosing spondylitis; aspartate transaminase; disease activity