Taylor Sarah A, Vittorio Jennifer M, Martinez Mercedes, Fester Keith A, Lagana Stephen M, Lobritto Steven J, Ovchinsky Nadia
Lurie Children's Hospital of Chicago, Chicago, Illinois.
Columbia University Medical Center, New York, New York.
Pharmacotherapy. 2016 Jan;36(1):e1-4. doi: 10.1002/phar.1677. Epub 2016 Jan 9.
The interleukin-1 (IL-1) family consists of 11 cytokines that play key regulatory roles in many immune and inflammatory processes. Anakinra (Kineret, Amgen, Inc.) is an IL-1 receptor antagonist (IL-1ra). Increased levels of IL-1 are found in several disease states suggesting that anakinra may be beneficial in disorders associated with elevated IL-1 levels. Anakinra has been effectively used in the treatment of systemic juvenile idiopathic arthritis and adult-onset Still's disease (AOSD). Despite its therapeutic benefits, anakinra also has potential side effects, including hepatotoxicity. We present a case of AOSD in an adolescent male that was treated with anakinra. During treatment, the patient developed acute liver failure that resolved upon withdrawal of anakinra. Although anakinra-induced liver injury has been reported in adults, including one case of subacute liver failure, we believe our case is the first to show severe acute liver failure in an adolescent treated with anakinra. This case provides significant insight into a potentially serious complication associated with anakinra. It is important to further delineate these complications as the treatment indications for this drug expand.
白细胞介素-1（IL-1）家族由11种细胞因子组成，这些细胞因子在许多免疫和炎症过程中发挥关键调节作用。阿那白滞素（Kineret，安进公司）是一种IL-1受体拮抗剂（IL-1ra）。在几种疾病状态下发现IL-1水平升高，这表明阿那白滞素可能对与IL-1水平升高相关的疾病有益。阿那白滞素已被有效地用于治疗系统性幼年特发性关节炎和成人斯蒂尔病（AOSD）。尽管有治疗益处，但阿那白滞素也有潜在的副作用，包括肝毒性。我们报告一例接受阿那白滞素治疗的青少年男性AOSD病例。治疗期间，患者出现急性肝衰竭，停用阿那白滞素后病情缓解。虽然阿那白滞素引起的肝损伤在成人中已有报道，包括一例亚急性肝衰竭，但我们认为我们的病例是首例显示接受阿那白滞素治疗的青少年出现严重急性肝衰竭的病例。该病例为与阿那白滞素相关的潜在严重并发症提供了重要见解。随着该药物治疗适应症的扩大，进一步明确这些并发症很重要。
