Year 2012 / Volume 104 / Number 5
Letter to the Editor
Recurrent hepatotoxicity associated with etanercept and adalimumab but not with infliximab in a patient with rheumatoid arthritis

pp.282-284

José Carlos Titos Arcos, Hacibe Hallal, Mercedes Robles y Raúl J. Andrade

Abstract
Tumour necrosis factor (TNF-a) antagonists are being com- monly used in the treatment of rheumatological, dermatological, and gastroenterological autoimmune diseases. At present, there are five marketed TNF-a antagonists: infliximab, adalimumab, etan- ercept, golimumab and certolizumab. All five agents bind directly to TNF-a, threreby inhibiting its signalling (1). Acute and long- term systemic toxicity is a concern with these immunomodulators and liver injury is increasingly been described, particularly with infliximab yet causality assessment in the setting of patients with potential confusion factors including treatment with other immuno- supressants, infection and neoplasm is difficult.
In this report, we describe a case of hepatotoxicity by etaner- cept first and then by adalimumab, in a patient with rheumatoid arthritis who lastly was safely treated with infliximab.
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José Carlos Titos Arcos, Hacibe Hallal, Mercedes Robles y Raúl J. Andrade. Recurrent hepatotoxicity associated with etanercept and adalimumab but not with infliximab in a patient with rheumatoid arthritis. 282-284


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