Can biologic medications cause liver damage?

Question

Hi Doctor,

I am a 47-year-old male patient. I have been taking injections of Adalimumab every two weeks for one year now to treat ulcerative colitis. At first, everything was fine; however, in the last three weeks, I am having bleeding with bowel movements six to seven times per day. The pain is not severe at all; however, I always have a feeling of urgency to go to the bathroom.

I had some tests done, and I found out that my liver enzymes are elevated (SGPT 78). Can biologic drugs cause slow destruction of the liver? Also, I feel that lately I am getting infected quite often, with throat infections, for example. Is there any chance that my immune system has been weakened by this drug?

Also, I am worried about the side effects of biologic treatment when you have to take it for many years. The worst-case scenario is that I will have to undergo surgery - what will change in my life after a colectomy? Do I have to use a bag permanently?

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. The occurrence of six to seven bowel movements per day accompanied by bleeding and urgency can occur among some individuals who previously had a good response when taking Adalimumab.

It will be essential for your doctor to evaluate the disease activity using tests such as CRP (C-reactive protein), calprotectin in stool, and even colonoscopy. At times, it might be important to test for the drug in your bloodstream in order to determine whether it is being metabolized too fast or not.

In respect of your raised liver enzymes, mild increases may be caused by different reasons such as medications, fatty liver, infections, or even other medicines. While Adalimumab may cause liver issues, the occurrence is very uncommon. Normally, your physician will consider other causes first before blaming the biologic.

Other potential symptoms that you might suffer from include more common small infections, such as throat infections, since biologics lead to a small degree of reduced immune activity. However, it is good to note that infections are typically minor in nature. It is recommended to keep yourself up-to-date with vaccinations.

There have been plenty of studies that have focused on the long-term effects of biologic drugs. However, at the same time, there are possible side effects, which include infections, infrequent immune response problems, and cancer in extremely rare cases.

If medications fail, surgery can be one treatment to look into. The typical surgical treatment involves the removal of the part of the colon affected by the disease through a process called colectomy. One surgery that is common is the ileal pouch–anal anastomosis or the J-pouch, where the patient’s body eliminates waste normally without the need for a colostomy bag.

It is essential to have these issues addressed by your gastroenterologist as early as possible because timely changes in your therapy will allow bringing the situation under control before the condition deteriorates further.

Should you find the above information useful, I would be happy to hear from you about that.

All the best!

Thank you.