Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2025; 17(7): 108051
Published online Jul 27, 2025. doi: 10.4254/wjh.v17.i7.108051
Three-year outcomes of tumor necrosis factor alpha inhibitor therapy in rheumatoid arthritis patients with elevated liver enzymes
Shivangini Duggal, Lakshmi Kattamuri, Shrilekha Sairam
Shivangini Duggal, Lakshmi Kattamuri, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
Shrilekha Sairam, Division of Rheumatology, Department of Internal Medicine, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
Author contributions: Duggal S and Kattamuri L were responsible for the investigation and review of relevant data and articles; Sairam S was responsible for review and editing; Duggal S, Kattamuri L, and Sairam S were responsible for this paper, data analysis, and the original draft; all authors discussed the findings described in the case and approved the final manuscript.
Institutional review board statement: The Institutional Review Board (IRB) acknowledges that this project meets the criteria for exemption from formal IRB review in accordance with 45 CFR 46.104(d)(4)(iii): The research involves only information collection and analysis involving the investigator's use of identifiable health information when that use is regulated under 45 CFR parts 160 and 164, subparts A and E [HIPAA], for the purposes of ''health care operations'' or ''research'' as those terms are defined at 45 CFR 164.501 or for ''public health activities and purposes'' as described under 45 CFR 164.512(b). The TTUHSC El Paso IRB has approved the Full Waiver of HIPAA Authorization after determining that the waiver of authorization satisfies the criteria set forth in the HIPAA Privacy Rule at (45 CFR 164.512(i)(2)). The waiver of authorization was reviewed and approved under expedited review procedures. The IRB has determined that the protected health information necessary to be used/accessed is as outlined in the protocol and/or IRB application.
Informed consent statement: It was exempted by Institutional Review Board.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shivangini Duggal, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX 79905, United States. sduggal@ttuhsc.edu
Received: April 8, 2025
Revised: April 29, 2025
Accepted: June 13, 2025
Published online: July 27, 2025
Processing time: 113 Days and 1.3 Hours
Core Tip

Core Tip: Rheumatoid arthritis (RA) patients often present with elevated liver enzymes, complicating the safe administration of immunosuppressive therapies. This retrospective study evaluated the hepatic safety of tumor necrosis factor inhibitors (TNFi)—etanercept and adalimumab—in RA patients with persistently elevated liver enzymes. Over a 3-year follow-up, TNFi therapy led to statistically significant improvements in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and fibrosis-4 scores, without hepatic decompensation or changes in Child-Pugh class. These findings suggest that TNFi therapy may be hepatologically safe and potentially beneficial in liver enzyme normalization among this high-risk population.