Hepatotoxicity of tocilizumab and anakinra in rheumatoid arthritis: management decisions

Figures & data

Table 1 Patient characteristics

Baseline patient features	Case 1	Case 2
Age	46	49
Year of diagnosis	2000*	1998*
Sex	Female	Female
Medical history	None	Infertility, hypertension, fatty liver
Previous treatment for rheumatoid arthritis	NSAIDs, MTX, Remicade^®**	NSAIDs, MTX
Baseline laboratory tests	GOT = 22 U/L	GOT = 16 U/L
	GPT = 18 U/L	GPT = 16 U/L
	LDH = 250 U/L	LDH = 364 U/L
	GGT = 25 U/L	GG = 21 U/L
	WBC (neutrophils %) = 7000 (77%)	WBC (Neutrophils %) = 9,500 (60%)
	HB = 14 g/dL	HB = 13.5 g/dL
	PLT = 178,000/cmm	PLT = 221,000/cmm
Concomitant medications	None	Atenolol
Body mass index	25	31
Alcohol consumption	None	None
History of liver disease	None	Nonalcoholic fatty liver disease

* Notes: American Rheumatism Association criteria¹³;

** Remicade^® (Janssen Biotech, Inc, Horsham, PA) against antitumor necrosis alpha (TNFα).

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; MTX, methotrexate; GOT, glutamic oxaloacetic transaminase; GPT, glutamic pyruvic transaminase; LDH, lactate dehydrase; GGT, gamma glutamyl transpeptidase; ALP, alkaline phosphatase; WBC, white blood cell; PLT, platelets; HB, hemoglobin.

Figure 1 Case 1: areas of hemorrhagic necrosis and steatosis.

Figure 2 Case 2: macrovesicular steatosis in 80% of the biopsy volume with focal necrosis of hepatocytes and lymphocytic infiltrates.

ArnettFCEdworthySMBlochDAThe American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritisArthritis Rheum1988313153243358796

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