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Infliximab caused DILI most frequently among TNF-a antagonists
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Among tumor necrosis factor-alpha antagonists, infliximab was most commonly associated with drug-induced liver injury, according to recent study data.
Einar S. Björnsson, MD, PhD, department of gastroenterology and hepatology, Landspitali University Hospital, Iceland, and colleagues identified patients exposed to tumor necrosis factor-alpha (TNF-a) antagonists at the National University Hospital of Iceland from 2009 through 2013. They compared the clinical characteristics of patients who developed drug-induced liver injury (DILI) after taking TNF-a with those of patients who did not.
Einar S. Björnsson
“Patients who are put on these drugs should be aware of the possibility that adverse liver reaction can occur,” Björnsson told Healio.com/Gastroenterology. “This happens in approximately one out of 120 treated and for infliximab this happens most of the time after approximately 12 to 14 weeks.”
During the 5-year study period, 11 patients were diagnosed with DILI associated with TNF-a antagonists. Researchers said 1,076 patients began infliximab therapy with one of every 120 developing DILI. Two hundred seventy patients received adalimumab and one developed DILI, and of 430 patients who initiated etanercept therapy, one experienced DILI.
Median duration of anti-TNF therapy was 3.3 months in patients who developed DILI vs. 26 months for those who did not (P=.0004). Four patients had jaundice at DILI diagnosis, and eight had hepatocellular liver injury. Only 9% of the DILI group received methotrexate during anti-TNF-a therapy compared with 59% of those who did not develop DILI (P=.009).
“Liver injury associated with the use of TNF-alpha antagonists is more common than previously reported, occurring in 1 out of 120 of those exposed to infliximab,” the researchers concluded.
“These reactions are usually not serious and either resolve with cessation of the drug or require short-term steroid therapy,” Björnsson said.
The researchers said methotrexate seemed to decrease DILI risk, patients recovered with either short-term steroids or cessation of anti-TNF therapy, and a second round of anti-TNF therapy was safe after recovery.
Disclosure: The researchers report no relevant financial disclosures.
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