Liver injury caused by tofacitinib in a child with juvenile idiopathic arthritis
10.3760/cma.j.cn114015-20210830-00942
- VernacularTitle:托法替布致幼年特发性关节炎患儿肝损伤
- Author:
Yaqun XIONG
1
;
Shihai ZHOU
;
Xinghua XIAO
;
Ping LUO
Author Information
1. 中南大学湘雅医院药学部，长沙 410008
- Publication Type:Journal Article
- Keywords:
Arthritis, juvenile rheumatoid;
Janus kinases;
Chemical and drug induced liver injury;
Off-label use;
Tofacitinib
- From:
Adverse Drug Reactions Journal
2022;24(5):266-268
- CountryChina
- Language:Chinese
-
Abstract:
An 11-year-old boy received tofacitinib (oral 7.5 mg once daily) on the basis of methotrexate therapy (oral 10 mg once a week) due to poor control of juvenile idiopathic arthritis, and the symptoms were relieved. The boy′s liver function was normal before using tofacitinib. After more than 2 months of combined use of the 2 drugs, laboratory tests showed alanine aminotransferase (ALT) 178 U/L and aspartate aminotransferase (AST) 78 U/L. No intervention was given because there were no clinical symptoms. His liver enzyme elevated significantly (ALT 586 U/L, AST 170 U/L) after continued medication for 1 month. After excluding viral hepatitis, autoimmune hepatitis, and other liver diseases, drug-induced liver injury was considered. Methotrexate was discontinued, tocilizumab was added, and liver protection therapy with reduced glutathione and magnesium isoglycyrrhizinate was given. Eleven days of methotrexate withdrawal, the laboratory tests showed ALT 512 U/L and AST 194 U/L. Then tofacitinib was discontinued and hepatic enzyme decreased significantly (ALT 150 U/L, AST 41 U/L) 3 days later. The liver injury was considered to be related to tofacitinib. The liver protection therapy was continued for 1 week, and the liver function examination showed ALT 41 U/L and AST 35 U/L.
