Can biologic medications cause liver damage?

Question

Hi doctor,

I am a 47-year-old male. I have been receiving Adalimumab injections every two weeks for the past year to treat ulcerative colitis. Initially, the treatment worked very well, but over the last three weeks, I have started to experience bleeding again, with bowel movements around six to seven times daily. While the pain is not very severe, I do have a constant urge to use the restroom.

I recently had some tests done, and my liver enzymes are slightly elevated (SGPT 78). Can biologic medications slowly damage the liver? Additionally, I have been experiencing frequent minor infections, such as throat infections. Could this be a sign that my immunity is weakened due to this medication?

I am also concerned about the long-term risks of being on biologics for many years. In the worst-case scenario, if surgery becomes necessary, how would life change after a colectomy? Would I need to use a permanent bag? I would appreciate a detailed explanation so I can mentally prepare for all possibilities.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns.

Our symptoms suggest that your ulcerative colitis may be entering a phase known as loss of response to biologic therapy. It is not uncommon for some patients to experience an increase in stool frequency to six to seven times daily, along with bleeding and urgency, especially after initially responding well to treatment with Adalimumab.

Your doctor needs to reassess the disease activity through tests such as CRP (C-reactive protein), stool calprotectin, and possibly a colonoscopy. In some cases, checking your blood drug levels can help determine whether the medication is being eliminated too quickly or if your body is developing antibodies against it.

Regarding your elevated liver enzymes, mild elevations can be due to various factors, including medications, fatty liver, infections, or other drugs. Although Adalimumab can affect the liver, such instances are rare. Generally, your doctor will monitor liver tests and evaluate other potential causes before attributing it to the biologic.

You may also experience more frequent minor infections, like throat infections, due to the slight suppression of immune activity caused by biologics. Fortunately, most infections are mild and manageable. It is advisable to keep vaccinations up to date and to report any persistent infections to your healthcare provider.

The long-term use of biologics has been well-studied. At the same time, there are risks, including infections, rare immune reactions, and, very rarely, certain types of cancer. These medications are generally regarded as safe and effective for long-term management, especially with regular monitoring.

If medications are no longer effective, surgery might be an option to consider. This usually involves removing the diseased portion of the colon (colectomy). Many patients undergo a procedure called ileal pouch–anal anastomosis (J-pouch), which allows for normal stool passage without the need for a permanent bag. While a temporary ileostomy bag may be necessary during recovery, it can often be reversed later.

It is important to discuss these concerns with your gastroenterologist soon, as making timely adjustments to your treatment can help restore control and prevent further progression of the disease.

If you found this information helpful, I would greatly appreciate your feedback. Wishing you comfort and steady improvement ahead.

Thank you.