title: Anti-tumour necrosis factor agent and liver injury: literature review, recommendations for management.
abstract: Abnormalities in liver function tests, including transient and self-limiting hypertransaminasemia, cholestatic disease and hepatitis, can develop during treatment with anti-tumour-necrosis-factor (TNF) therapy. The optimal management of liver injury related to anti-TNF therapy is still a matter of debate. Although some authors recommend discontinuing treatment in case of both a rise of alanine aminotransferase more than 5 times the upper limit of normal, or the occurrence of jaundice, there are no standard guidelines for the management of anti-TNF-related liver injury. Bibliographical searches were performed in PubMed, using the following key words: inflammatory bowel disease (IBD); TNF inhibitors; hypertransaminasemia; drug-related liver injury; infliximab. According to published data, elevation of transaminases in patients with IBD treated with anti-TNF is a common finding, but resolution appears to be the usual outcome. Anti-TNF agents seem to be safe with a low risk of causing severe drug-related liver injury. According to our centre experience, we found that hypertransaminasemia was a common, mainly self-limiting finding in our IBD cohort and was not correlated to infliximab treatment on both univariate and multivariate analyses. An algorithm for the management of liver impairment occurring during anti-TNF treatment is also proposed and this highlights the need of a multidisciplinary approach and suggests liver biopsy as a key-point in the management decision in case of severe rise of transaminases. However, hepatic injury is generally self-limiting and drug withdrawal seems to be an exception.
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Roberta Elisa
authors.initials: RE
authors.lastname: Rossi
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Parisi
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Edward John
authors.initials: EJ
authors.lastname: Despott
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Andrew Kenneth
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Mark Ian
authors.initials: MI
authors.lastname: Hamilton
authors.affiliation: Roberta Elisa Rossi, Edward John Despott, Mark Ian Hamilton, Charles Daniel Murray, Centre for Gastroenterology, Royal Free Hospital, London NW3 2QG, United Kingdom.
authors.forename: Charles Daniel
authors.initials: CD
authors.lastname: Murray
mesh_terms: D000465:Algorithms; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001688:Biological Products / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000378:metabolism / Q000628:therapy; D019091:Critical Pathways; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism; D008111:Liver Function Tests; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Drug-related liver injury; Hypertransaminasemia; Inflammatory bowel disease; Infliximab; Tumour necrosis factor inhibitors