Additional effect of etanercept or infliximab on the liver function tests of patients with rheumatoid arthritis: A cohort study

Akhlaghi, S. and Sahebari, M. and Mahmoodi, M. and Yaseri, M. and Mansournia, M. A. and Rafatpanah, H. and Zeraati, H. (2018) Additional effect of etanercept or infliximab on the liver function tests of patients with rheumatoid arthritis: A cohort study. Therapeutics and Clinical Risk Management, 14. pp. 1943-1950.

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Abstract

Purpose: One of the most important long-term side effects of therapy for rheumatoid arthritis (RA) is the elevation of liver function tests, with earlier studies reporting an elevation of more than 1× the upper limit of normal (>1 × ULN). The current study expands the literature by comparing the trends of transaminase changes caused by conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Patients and methods: The drug categories examined were methotrexate (MTX) and all other nonbiologic DMARDs. Where RA patients exhibited inadequate response to conventional DMARDs (cDMARDs), we added biologic DMARDs (bDMARDs) to the treatment. We compared the trend of changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the patients receiving MTX with the trend observed in the patients whose treatment encompassed both bDMARDs and MTX. The comparison was conducted using random intercept models, which are a type of linear mixed effects model. Results: This work involved 512 RA patients (MTX: 450, MTX + infliximab INF: 26, MTX + etanercept ETA: 36), whose ALT and/or AST levels were measured in 1,786 visits (MTX: 1,543, MTX + INF: 107, MTX + ETA: 136). ALT and/or AST elevations greater than 1 × ULN were observed in 344 (19.3%) visits (MTX: 295 19.1%, MTX + INF/ETA: 49 20.2%). In this study, the trends of ALT and AST changes increased when receiving MTX, while the INF/ETA addition decreased these trends. The random intercept models indicated that changes in the mean ALT levels were significantly different over the time for MTX and MTX + INF/ETA groups (β SE =-0.190 0.093, P= 0.040) but changes in the mean AST levels were nonsignificantly different over the time for such groups (β SE =-0.099 0.064, P=0.120). Conclusion: Despite a higher incidence of elevated transaminases during the use of MTX + INF/ETA, the combination of INF/ETA with MTX reduced transaminase levels and returned ALT levels to normal concentrations. © 2018 Akhlaghi et al.

Item Type: Article
Additional Information: Export Date: 16 February 2020 Correspondence Address: Zeraati, H.; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical SciencesIran; email: zeraatih@tums.ac.ir
Uncontrolled Keywords: ALT AST Biologic DMARDs DMARDs Longitudinal MTX alanine aminotransferase aspartate aminotransferase etanercept infliximab liver enzyme methotrexate adult alanine aminotransferase blood level Article aspartate aminotransferase blood level cohort analysis confidence interval controlled study drug effect drug mechanism female follow up human incidence intermethod comparison liver function test major clinical study male rheumatoid arthritis treatment outcome trend study
Subjects: WE Musculoskeletal system
WI Digestive System
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 10 Jun 2020 05:25
Last Modified: 10 Jun 2020 05:25
URI: http://eprints.mums.ac.ir/id/eprint/17176

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