Kevzara lab , liver enzymes

I've been taking Actemra injections weekly for over a year. It is a biologic drug similar to Kevzara, and requires similar monitoring of liver enzymes. I had a blood test a few weeks ago that included the liver enzymes. My ast and alt were in the normal range. According to my report, your ast value is barely above normal, which is < = 40. That puts it in the moderately high range. The alt value would be more concerning to me. According to my report, the moderately high range is 45 to 70. I would think your doctor would keep a close eye on those values, and change medications if necessary.

Most of the time mildly elevated liver enzymes are not too concerning. There are many reasons why liver enzymes might be elevated. Many medications affect the liver which is why liver enzymes should be monitored for patients on Kevzara. Mild elevations are sometimes temporary but if your liver enzymes trend higher over time something may need to be done.
https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/definition/sym-20050830
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My liver enzymes with ALT and AST levels approaching 100 were persistent and considered to be moderately elevated when I started Actemra while I tapered off Prednisone. My rheumatologist consulted a liver specialist just to get their opinion.

The liver specialist asked me many questions. For example, there were questions about my alcohol intake which I rarely do. There was evidence for fatty liver disease on an old CT-scan done when I had abdominal pain from kidney stones. In the end, the liver specialist didn't see any need for me to stop Actemra.

What was more interesting to me was how my liver enzymes normalized over time after I tapered off Prednisone. I continue to see an endocrinologist for metabolic syndrome. The endocrinologist said that prednisone had a profound effect on my metabolism.

The endocrine system is very complicated. My endocrinologist seemed to believe that since my cortisol was lower than the normal initially when I tapered off prednisone, my liver enzymes were elevated because of adrenal insufficiency caused by glucocorticoid withdrawal.

I should add that my doctors were always clear about when they were speculating and when they actually knew something!!! They rarely said they knew anything with 100% certainty. I'm glad my doctors weren't the type who felt they were entitled to know everything. They explained things to me as best as they could. It was clear that my doctors knew more than me so I was inclined to listen intently to them.