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Kevzara and elevated liver enzymes ALT AST
Ten weeks after starting Kevzara my ALT & AST readings went from normal to very high values. (ALT = 137, AST = 54) As a result, I'm proceeding w/ imaging for my liver to see what we can see. Kevzara has enabled me to break through my prednisone taper barrier of 10mg, so I'm now down to 5 and dropping a mg every couple of weeks. Now I'm concerned these readings could result in me having to stop Kevzara, but hoping not. I'm tapering a bit faster than normal (5mg in 10 weeks) because I am able which might be contributing. I've reported this to my Rheumatologist and am awaiting his thoughts. Has anyone else experienced something similar?
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There are definitely people here who've said they had to discontinue Kevzara because of liver problems or serious infections. Hopefully some will reply to you shortly.
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2 ReactionsElevated liver enzymes are a possible side effect of Kevzara. The reason for this is unknown.
"Mechanism of Injury
Sarilumab is a monoclonal antibody and has minimal hepatic metabolism. The mechanism by which it might cause liver injury is unknown, but may be the result of its effects on the immune system or on the IL-6 pathway which is important in liver regeneration. A similar pattern of enzyme elevations occurs with tocilizumab, another monoclonal antibody to the IL-6 receptor used to treat rheumatoid arthritis."
https://www.ncbi.nlm.nih.gov/books/NBK547964/
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I don't have any experience with Kevzara but my liver enzymes were elevated on Actemra (tocilizumab). I was referred to a liver specialist to determine the cause. My elevated liver enzymes were likely caused by nonalcoholic fatty liver disease (NALFD) , which is a condition where fat builds up in the liver. It's not caused by heavy drinking.
I was diagnosed with metabolic syndrome from long term Prednisone use. Fatty liver disease is one characteristic of metabolic syndrome.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7171875/#:~:text=Even%20short%20term%20(days)%20excessive,chronically%20elevated%20levels%20of%20cortisol.&text=Similar%20changes%20are%20also%20seen,of%20glucocorticoids%20for%20prolonged%20periods.&text=In%20this%20manuscript%2C%20we%20will,in%20a%20subset%20of%20patients.
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My elevated liver enzymes did not result in stopping Actemra. In the guidelines for Kevzara your doctor has some discretion on what to do about your liver enzymes.
Liver Enzyme Abnormalities:
Lab Value Recommendation
ALT greater than Upper Limit of Normal (ULN) to 3 times ULN or less; Consider dosage modification of concomitant DMARDs as clinically appropriate.
ALT greater than 3 times ULN to 5 times ULN or less:
Hold treatment with KEVZARA until ALT less than 3 times ULN.
KEVZARA can then be resumed at 150 mg every two weeks and
increased to 200 mg every two weeks as clinically appropriate.
ALT greater than 5 times ULN
Discontinue KEVZARA.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761037s001lbl.pdf
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Sometimes liver enzymes elevations are transient. The ULN for ALT is variable depending on the lab. Your ALT is close to 3X the upper limit of normal. Let us know what your doctor decides. I don't think your ALT is high enough to warrant stopping Kevzara permanently according to the guidelines.
My liver enzymes are now closer to normal after I tapered off Prednisone. My lipid panel also improved so I was able to stop taking atorvastatin. Statins can also cause elevated liver enzymes.
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3 ReactionsBig help, many thanks!!
No problem … been there … done that.
Many medications were hard on my liver. Methotrexate and NSAIDs were too. Prednisone long term causes metabolic syndrome which has lasting effects. Everything combined isn’t good.
I still have a beer belly even though I rarely consume any alcohol. My beer belly is gradually getting smaller but still needs a lot of work.
My kidneys are impaired too. Fortunately we are designed well so our liver and kidneys can handle most things that are toxic in the long term. The liver in particular has an incredible ability to regenerate itself.
I hope you can continue with Kevzara. It seems like it is working for you. Whatever Actemra does to me it was worth it to finally be off prednisone after all these years.
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1 ReactionI started Kevzara in November 2023. I was able to taper off Prednisone in about 3-4 months. All was fine until at the one year mark my ALT and AST increased suddenly. Rhuemie took me off Kevzara and in about 3 weeks my PMR pain returned and my CRP shot way up. So now back on 20 mg of prednisone again. Now I feel great but imagine it won’t last. With Kevzara the pain gradually crept back in and probably will with the prednisone
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1 ReactionThat is so unfortunate. You were doing so well and then all of a sudden… Are you saying that your PMR pain that gradually crept back in was when you were on Kevzara?
I’ve been on Kevzara for 10 mos. 3 of those months were while tapering off of prednisone and the remaining 7 mos have been on Kevzara alone. My pain is mostly gone and has been since starting Kevzara. I’ve had no side effects and for the past 3 months I have been taking my Kevzara every 3 weeks instead of every two weeks. I’m anxious to get off of it for the same reasons we all want to be drug free but the cost is my other driving force. The drug company discontinued my assistance and it’s just prohibitive.
Yes the pain gradually came back as I neared the one year mark. Of course it was after I had met my insurance out of pocket maximum and the end of the year. It was very expensive. The Kevzara didn’t do much for my fatigue overall and caused swelling too. Never did “go into remission”.