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Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Authors

  • Carla S. Coffin MD, MSc, FRCPC,

    Corresponding author
    1. Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
    • Liver Unit, Division of Gastroenterology, Teaching, Research and Wellness Centre, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
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  • Hughie F. Fraser MD, FRCPC,

    1. Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Remo Panaccione MD, FRCPC,

    1. Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Subrata Ghosh MD, FRCP

    1. Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • The first two authors contributed equally to this work.

Abstract

The conventional treatment of inflammatory bowel disease (IBD) has focused on nonspecifically targeting mucosal inflammation. In the last decade, with the advent of novel biological agents that directly inhibit proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), rapid progress has been made in clinical management of complex and challenging patients with IBD. However, there remain many unanswered questions about the short and long-term side effects; this article focuses on hepatic complications. This review aims to provide a concise update to gastroenterologists on the well-known, as well as the potential rare consequences of anti-TNFα therapy on the liver and recommendations for clinical management. We performed a focused literature review for reports of the effect of anti-TNF therapy on preexisting liver disease as well as de novo hepatitis and drug-induced hepatotoxicity. Search terms used included anti-TNF therapy, biologics, liver disease, inflammatory bowel disease, hepatitis, hepatotoxicity, opportunistic infections,, and hepatitis virus reactivation. There are multiple potential effects of anti-TNF therapy on the liver during treatment of patients with IBD. Often treatment may be complicated by preexisting chronic liver disease. Clinicians should be aware of potential hepatic side effects and appropriate management options. (Inflamm Bowel Dis 2011;)

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