New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease.


BACKGROUND:Anti-tumour necrosis factor α (anti-TNF) agents have been implicated in drug-induced liver injury. There is minimal data on this occurrence in inflammatory bowel disease (IBD) patients. AIM:To identify the characteristics of liver enzyme elevations following anti-TNF therapy initiation in IBD. METHODS:A retrospective cohort of patients initiating anti-TNF therapy were analysed for new onset alanine transaminase (ALT) elevation (≥60 U/L). We collected data on natural history, outcomes and patient characteristics compared with controls with persistent normal liver enzymes. Likelihood of causal association was assessed using the RUCAM score. RESULTS:From 1753 patients initiating an anti-TNF (1170 infliximab, 575 adalimumab, 8 certolizumab), 102 (6%) developed new onset ALT elevation. In 54 (53%), this could be linked to an alternate aetiology. Among those with idiopathic ALT elevations, the median time to ALT elevation from anti-TNF initiation was 18 weeks and median peak ALT was 96 U/L. Six underwent liver biopsy, all demonstrating hepatitis with autoimmune features. Compared to controls, cases were on a lower dose of infliximab (5.7 vs. 6.7 mg/kg, P = 0.02) but were otherwise similar in body mass index, sex and age. On follow-up, 34 continued the anti-TNF, 14 stopped therapy and 4 initiated steroids. Most (85%) normalised their LFTs after a median of 17 weeks including 28 (82%) of those who continued anti-TNF therapy. Ten patients were transitioned to a second anti-TNF without recurrence. CONCLUSIONS:ALT elevations occurred in 6% of IBD patients initiating anti-TNF therapy. Most idiopathic elevations were mild, transient and resolved despite therapy continuation.


Aliment Pharmacol Ther


Shelton E,Chaudrey K,Sauk J,Khalili H,Masia R,Nguyen DD,Yajnik V,Ananthakrishnan AN




Has Abstract


2015-05-01 00:00:00












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    abstract:BACKGROUND:The combination of omeprazole and amoxycillin has demonstrated effectiveness with very few side-effects in the treatment of H. pylori infection, however cure rates have varied widely. The present study addresses the question as to the extent to which the cure rate of H. pylori infection depends on the size o...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 临床试验,杂志文章,随机对照试验


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  • Occupational asbestos exposure and digestive cancers - a cohort study.

    abstract:BACKGROUND:Although the role of asbestos in the genesis of mesothelioma and primary bronchopulmonary cancers has been established, results from studies focusing on the relationship between occupational exposure to asbestos and digestive cancer remain contradictory. AIM:To determine whether occupational asbestos exposu...

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    pub_type: 杂志文章


    authors: Clin B,Morlais F,Dubois B,Guizard AV,Desoubeaux N,Marquignon MF,Raffaelli C,Paris C,Galateau-Salle F,Launoy G,Letourneux M

    更新日期:2009-08-15 00:00:00

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    pub_type: 杂志文章


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,随机对照试验


    authors: Silk DB,Davis A,Vulevic J,Tzortzis G,Gibson GR

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    pub_type: 杂志文章


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    abstract::Beta adrenoreceptor blocking drugs have been used for the prevention of haemorrhage from oesophageal varices. However, it is possible that these agents, by virtue of their effects on hepatic blood flow, may impair liver function and precipitate hepatic encephalopathy. We have therefore studied the effect of the beta b...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 临床试验,杂志文章,随机对照试验


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,随机对照试验


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


    authors: Mattila E,Arkkila P,Mattila PS,Tarkka E,Tissari P,Anttila VJ

    更新日期:2013-01-01 00:00:00

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    abstract:BACKGROUND:Unable to resolve a medical problem, gastroenterologists occasionally choose an ineffectual intervention instead. The elusive path to effectual management becomes substituted with an ineffectual but readily available medical ritual. The term 'ritual' refers to the utilization of an ineffectual intervention w...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


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    pub_type: 临床试验,杂志文章,多中心研究


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    更新日期:2015-04-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,多中心研究,随机对照试验


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    更新日期:2017-01-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: DuPont HL

    更新日期:2008-05-01 00:00:00

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    abstract:BACKGROUND:Recent evidence found probiotics could inhibit Helicobacter pylori colonization from both in vitro and in vivo studies. AIM:To systematically evaluate whether adding probiotics to anti-H. pylori regimens could improve eradication rates and reduce side effects during anti-H. pylori treatment. METHODS:Eligib...

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    pub_type: 杂志文章,meta分析


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    更新日期:2007-01-15 00:00:00

  • Proactive therapeutic drug monitoring of infliximab: a comparative study of a new point-of-care quantitative test with two established ELISA assays.

    abstract:BACKGROUND:Therapeutic drug monitoring is a powerful strategy known to improve the clinical outcomes and to optimise the healthcare resources in the treatment of autoimmune diseases. Currently, most of the methods commercially available for the quantification of infliximab (IFX) are ELISA-based, with a turnaround time ...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


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    更新日期:2016-10-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 临床试验,杂志文章


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


    authors: Woods KL,Kiefe C,Graham DY

    更新日期:1996-06-01 00:00:00

  • An analysis of the placebo effect in Crohn's disease over time.

    abstract:BACKGROUND:Randomized, placebo controlled trials are used to assess the efficacy of therapies for Crohn's disease. The placebo response and remission rates vary among studies. AIM:To analyse how the placebo response and remission rates in Crohn's trials have changed over time in the era of parenteral biologic therapie...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


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    更新日期:2010-01-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,多中心研究


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  • Correlation of MAP kinases with COX-2 induction differs between MKN45 and HT29 cells.

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


    authors: Tominaga K,Higuchi K,Sasaki E,Suto R,Watanabe T,Fujiwara Y,Oshitani N,Matsumoto T,Kim S,Iwao H,Arakawa T

    更新日期:2004-07-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,meta分析


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    更新日期:2013-05-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


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    更新日期:2000-05-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


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    更新日期:2005-06-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


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    更新日期:2008-09-15 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,多中心研究


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


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    更新日期:2006-03-15 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章,评审


    authors: Lémann M

    更新日期:2006-10-01 00:00:00