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Treatment of rheumatoid arthritis with conventional, targeted and biological disease-modifying antirheumatic drugs in the setting of liver injury and non-alcoholic fatty liver disease

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Abstract

Increased incidence of liver diseases emphasizes greater caution in prescribing antirheumatic drugs due to their hepatotoxicity. A transient elevation of transaminases to autoimmune hepatitis and acute liver failure has been described. For every 10 cases of alanine aminotransferase (ALT) elevation in a clinical trial, it is estimated that one case of more severe liver injury will develop once the investigated drug is widely available. Biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic (tsDMARDs) are less likely to cause liver damage. However, various manifestations, from a transient elevation of transaminases to autoimmune hepatitis and acute liver failure, have been described. Research on non-alcoholic fatty liver disease (NAFLD) has provided insight into a pre-existing liver disease that may be worsen by medication. Diabetes and obesity could be an additional burden in drug-induced liver injury (DILI). In the intertwining of the inflammatory and metabolic pathways, the most important cytokines are IL-6 and TNF alpha, which are also the cornerstone of biological treatment for rheumatoid arthritis. This narrative review evaluates the complexity and prevention of DILI in RA and treatment options involving biological therapy and tsDMARDs.

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The datasets generated during the current study are available from the corresponding author on reasonable request.

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  1. Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Rijeka, Faculty of Medicine Rijeka, University of Rijeka, Rijeka, Croatia

    Tatjana Zekić

  2. Department of Pharmacology, Clinical Hospital Center Rijeka, Rijeka, Croatia

    Mirjana Stanić Benić

  3. Department of Rheumatology, Clinical Immunology and Allergology, Faculty of Medicine Split, University of Split, Clinical Hospital Center Split, Split, Croatia

    Mislav Radić

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Zekić, T., Benić, M.S. & Radić, M. Treatment of rheumatoid arthritis with conventional, targeted and biological disease-modifying antirheumatic drugs in the setting of liver injury and non-alcoholic fatty liver disease. Rheumatol Int 42, 1665–1679 (2022). https://doi.org/10.1007/s00296-022-05143-y

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