Steroids improve liver test abnormalities in infliximab-induced liver injury: Study
Iceland: Liver injury and liver inflammation is a rare side effect of infliximab, a biological medicine used to treat multiple inflammatory diseases. In a recent study involving 36 patients with infliximab-induced liver injury, about half of the patients were treated with steroids. The results, published in the Journal of Hepatology suggest that patients who received steroids recovered faster.
The researchers observed a good treatment response with prompt resolution of liver test abnormalities in patients with prolonged elevations in ALT after cessation of infliximab therapy who were treated with corticosteroids. Moreover, no patients developed a relapse of liver injury following the discontinuation of corticosteroid treatment. Overall, 75% of patients switched to another biologic agent, and no drug-induced liver injury (DILI) was seen due to the second biologic.
Infliximab is known to be associated with DILI, particularly drug-induced autoimmune hepatitis (DIAIH). DIAIH is treated commonly with corticosteroids but data on the efficacy of corticosteroids in infliximab-induced DILI is limited. Considering this Helgi Kristinn Björnsson, the University of Iceland, Faculty of Medicine, Reykjavik, Iceland, and colleagues aimed to gather some data on the topic.
For this purpose, the patients who were treated with infliximab between 2009-2020 in Iceland and developed elevated liver tests were included. Other specific etiologies of liver enzyme elevations were excluded. Patients treated with corticosteroids were compared to those who did not receive corticosteroids.
A total of 36 patients with infliximab-induced DILI were identified: median age was 46 years and 28 (78%) were female.
Following were the study's key findings:
- Type of liver injury was predominantly hepatocellular (64%).
- Median peak liver enzymes were: alanine aminotransferase (ALT) 393 U/L, aspartate aminotransferase 283 U/L, alkaline phosphatase 116 U/L, and bilirubin 13 μmol/L.
- A total of 25 (69%) were positive for anti-nuclear antibody and/or had elevated IgG.
- Corticosteroids were initiated in 17 (47%).
- Median time from onset of liver injury to peak ALT value was longer in patients treated with corticosteroids, 22 vs. 0 days.
- Time from peak ALT to normalization of liver enzymes was 45 days in the corticosteroid group vs. 77 days in others.
- Corticosteroids were tapered in all patients, with no cases of relapse during the follow-up period of 1,245 days.
- Overall 75% received another biologic, mostly adalimumab, without evidence of liver injury.
"In this study of 36 patients with infliximab-induced liver injury, approximately half of patients were treated with steroids and the results suggest that patients receiving steroids recover more quickly," the authors concluded.
Reference:
The study titled, "Infliximab-induced liver injury: Clinical phenotypes, autoimmunity and the role of corticosteroid treatment," was published in the Journal of Hepatology.
