I've been lucky enough not to have had elevated liver enzymes with MTX, Enbrel or three other biologics after Enbrel.

However, bcatz, it does look as though Enbrel is the villain for you, seeing that it also happened when you were on Enbrel the first time.

Hope you can sort this out with your doctor as soon as possible. I'd be nervous, too. I have had so many rare side effects or allergy to every RA med or biologic so far, except for MTX.

I have had an elevated ALT (251) once. My Dr had me stop methotrexate for 3 weeks, then start at half the dose. For me, that did work. Good luck on getting your numbers down.

I have been worrying about my liver to. So we could just worry together. Lol. Sound like you have it right about the Enbrel. In my case it has to be the mtx. My last numbers were Alt 64 and Ast 42. That been a month ago. Rheumy said to stick to my regular dosage for now and we will keep a good eye on them. I was just wondering what is a dangerous level for these numbers and what are the risks. I know the liver will repair itself with stopping the drugs but how high can they go before irreversible damage has occured. 2leftfeet- did it take a long time to get that 251 back down?

Bcatz, sorry your having troubles with those number and hope you get them back down soon especially since you been feeling pretty good as of late.

The Rheum had me off MTX for the 3 weeks, then 2 weeks after I started the lower dose, I went in for testing, and the levels had dropped to a safe level. He had me go back in again, 4 weeks later, retest, just to be sure. It has been OK ever since. That was over a year ago, and I am still on the lower dose, and good levels.

The only other thing I've had were the 3 facet joint injections with steroid. I don't know which steroid but I can't imagine that the enzymes would be as high as 178.


My rheum doc's office has a messaging center. I looked over my notes to the doc and found one in Sept 2011 where I asked about an increase in my numbers. He said he'd lower the MTX if it went out of range...I'd been taking Enbrel at that time for about 7 weeks. The next blood work was November where it was over 100 (like now) and then went as high as 500+ for ALT. AST was around 300 at the time. Ratios are similar with ALT being almost twice as high suggestive of drug induced toxicity.

My last Enbrel injection was Sun morning, 24hrs prior to blood work so it probably fully registered in the liver function test.

I'm just in dismay! I find very little information on elevated liver enzymes on Enbrel. I did find some clinical studies with it for folks with AS and the elevations are similar. But, since they require you to get liver checked on Enbrel, there must be more than a small chance of increased enzymes.

My rheum. doc called this evening. He does not think it's the Enbrel. He told me he has patients with autoimmune hepatitis on Enbrel..and others with no issues. He gave a slight disclaimer that I could somehow be the only one.

Doc pointed to fatty liver thinking something insulted it. (how rude!) I get blood work Monday and we'll go from there. Hopefully it's down.

Well that sux!
If Enbrel can cause autoimmune hepatitis and that causes the liver enzymes to elevate- then it's the damn Enbrel.

No wonder I want to do my best to stay off the toxic RA drugs as long as I can stand the pain and do not see physical deformities. All the drugs come with trade offs.

Hope things settle down for you. Wishing you all my best

I made a pig of myself today and my belly is enormously bloated like a 7 month pregnancy.
Can't sleep for crap- up at 3 - toss and turn until 6 when its time to get up
Wrist pain today
Oh happy day- all this and prednisone too.....

If I get a dowagers hump I'm done

Thinks, Do you sleep with wrist rests? Those helped me so much, if only to keep the wrist in a set position.

I agree with you that Enbrel can elevate the liver and it'd be a crazy coincidence that it has happened twice and not be it. But, I know my doctor is going off his own experience.
While I'm still NOT going to take an Enbrel shot before my blood work Monday, I will admit my diet has been beyond horrible. I don't mean just bad here and there. I mean HORRIBLE. Fast food and donuts both make the list. Not sure where my brain is when I'm consuming such evil but I sure did get a kick in the pants with the lab work!

Thankfully never had that problem on Enbrel. Through the time I was on it went for all my blocks & procedures for the cervical also never seem to bother the liver. Only increase for me was the short time I did attempt the MTX.
We are all different of course just strange how we can react to meds.
Perhaps it's the combination your liver does not like. Just a thought.
Wishing luck.
Sammy

bcatz- does fast food and sugar elevate liver enzymes? I did not know that.
Now if you told me you were having a nightly cocktail like I enjoy....

Well, technically eating badly can cause fatty liver which can elevate liver enzymes. But my AST is usually 20-25 and ALT is usually 23-30. Can't imagine my bad eating screwed things up in three months. But maybe?

And, how can this be disputed??? (from livertox.gov)

Hepatotoxicity




"Etanercept has been associated with low rates of serum ALT elevations during therapy that are generally asymptomatic, transient, and do not require dose modifications. There have been isolated reports of clinically apparent liver injury during etanercept therapy, but the frequency has been far less than with infliximab, and several patients with infliximab induced liver injury have been reported to tolerate etanercept without recurrence. Etanercept therapy can be associated with induction of autoantibodies, including antinuclear antibody (ANA) and cases of autoimmune hepatitis, induced or exacerbated by etanercept therapy have been reported. The latency to onset has ranged greatly, from as short as 2 weeks to as long as several years. The pattern of serum enzyme elevations has also varied, both cholestatic and hepatocellular injury being reported. Immunoallergic manifestations such as fever, rash and eosinophilia are rare. Autoimmune phenomena are reported and the injury is reportedly responsive to corticosteroid therapy. How frequently the disease recurs after corticosteroids are discontinued has not been carefully assessed.

The hepatotoxicity of etanercept has largely been mild and self-limiting, although sometimes requiring corticosteroid therapy."

you know the googling is awesome and it is wonderful to read and research.

I am thinking that you might want to make an appointment with a liver doctor, hepatologist.?

I really adored mine, she had a smart brain (like you girlfriend :)
and she reviewed my entire RA life and before. she even looked at bloodwork from 10 years back!

she scanned my liver and we got down to business. JUST in case you have any co-issues that are making this dance.

i think it would be well worth the 15 minutes

Depot

Depot, thanks! My rheum doc told me that if I felt better we could add my GI doc into the mix like we did 4 yrs ago. I know my rheum. is basing thoughts on his experience with drugs including my history. When he called, he went through all drugs (did you know docs can access our rx history even if they were not sent the info??) including drugs I filled but then didn't take or quit. (buspar)

I will totally loop in the GI doc but I figure I should go Monday to see what the blood work is, then go from there. In the meantime, my mind is left to "wander". :)

i did not see a gastroenterologist I saw a hepatologist and her only specialty was the liver, nothing else. your numbers are interesting. she might make a good team player. the one I saw had an entirely different set of tactics than the rheumatologist.

primary care made the referral NOT the rheumatologist. the MRI of the liver was pretty helpful. the liver biopsy was up next if the numbers did not behave over a long haul. all appointments were copied to the rheumatologist though.

i do a lot of self care but not with my liver :)