I can't comment on your case. When I reviewed this issue a few years ago, when I had a patient with hepatitis on GA (Copaxone), the diagnosis was likely comorbid autoimmune hepatitis rather than Copaxone. It is difficult to prove, but most of the patients with hepatitis on Copaxone have other biomarkers associated with autoimmune hepatitis.
It was quite a thorough investigation by hepatology as I think my ALT was initially 10xULN. They told me they would inform the drug company. It's been around 4 years since it happened. I started Ocrevus when my liver recovered and have so far had no elevated LFTs. I will definitely keep an eye on my results though.
One thing I often wonder about: I had glandular fever during my master's degree (about 7 years before MS diagnosis). In addition to the normal symptoms, I had a very tender right flank. The doc said it was hepatitis in response to glandular fever. I do wonder if this means I have a particularly sensitive liver -- if that's even a thing. Anyway, this MS-Selfie has reminded me about those times. Cheers for the explanation!
Hepatitis is an uncommon complication of IM. However, once recovered, the liver usually gets back to normal. Unlike the CNS, the liver has a remarkable ability to recover function.
Could you add a list of symptoms for liver injury or diseases that we can reference? I only know eyes or skin looking yellow and nausea. Can we tell anything about liver health from stool colour? Mine are often tan coloured or very light brown.
For how long after taking the last Cladribine pill do I need to be concerned about liver issues? Y2 bloods at 6 months liver function panel was all in range.
Liver dysfunction often presents with fatigue, loss of appetite, weight loss, and jaundice (yellowing of the skin/eyes). Other common signs include swollen abdomen or legs, itchy skin, dark urine, pale stools, easy bruising, and confusion. These latter symptoms are due to liver failure and do not appear until advanced liver damage occurs.
Abnormal LFTs after being exposed to a drug associated with DILI are typically in the first 8-12 weeks, i.e. when the drug is around and induces an immune response due to the so-called hapten effect.
I don't see my blood results from the hospital unless I request them on a SAR. Recently I've been doing this so that I know what they are. I like this type of information because it comes from a trusted source and saves me searching the internet for an explanation that might be written in Medspeak, not something approaching English that I can understand and is tailored towards MS ifvsppli coThree months after starting Siponimod my ALT was 159. The acceptable range is given as 0 - 32, so effectively 5 x ULN. ALP was 158 and GGT was 111. If AST was measured it must have been normal as I haven't made a note of its value. Nobody said anything until I queried why my next monitoring blood test was early and was told they wanted to check my liver because it's results were a bit high last time. I think this request came in May but I didn't have the sample taken immediately. The results from the 11th June show that ALP and ALT had returned to normal and GGT was 49.
My next monitoring blood test should be at the end of February. Assuming they do measure AST, is it likely to be higher because of my knee replacement on 29th November?
The AST is not part of the LFT panel done on the NHS. AST is also released from muscle damage and hence is not specific for liver disease. It has to be requested separately.
1 am not able to understand all the values, but the alert to watch for liver damage and ask for teats is sound and useful. Mother of Hannah who had a baby September 9th. We miss you in practice.
Prof G, I have always been prone to having slightly higher lfts. My bmi is about 29 and they definitely seem to go down when I drop some weight. I’ve had a normal ultrasound and normal fibrosis blood panel. Here is a recent round
AST: 35
ALT: 62
ALP: 119
Would this alt of 62 spook a neurologist to start someone like me on fenebrutinib once it was approved? I figure I have between now and approval to shed some pounds and get these labs in line.
The upper limit of normal for ALT varies by country. The typical range cited for adults is 7-56 IU/L; males tend to have higher upper limits of normal (45-60 IU/L) than females (34-40 IU/L). An ALT of 62 is just above normal and not clinically significant if all the other tests for diseases of the liver have been excluded. This should not be a contraindication to starting a therapy with a potential hepatotoxicity. What is important is monitoring any change.
I am getting my liver looked at because my GGT and my ALT are elevated and I had no idea before doing the blood work for MS. I hope I can get it back into acceptable levels to be able to take medication. I was tested for Hepatitis and I don’t have it.
You need more investigations than just excluding hepatitis. Do you know what type of hepatitis was tested for? There are several viruses that infect the liver. Keep us posted on the outcome.
I had toxic hepatitis from Copaxone! After investigating autoimmune hepatitis, they ruled this out and concluded it was a rare reaction to Copaxone.
I can't comment on your case. When I reviewed this issue a few years ago, when I had a patient with hepatitis on GA (Copaxone), the diagnosis was likely comorbid autoimmune hepatitis rather than Copaxone. It is difficult to prove, but most of the patients with hepatitis on Copaxone have other biomarkers associated with autoimmune hepatitis.
It was quite a thorough investigation by hepatology as I think my ALT was initially 10xULN. They told me they would inform the drug company. It's been around 4 years since it happened. I started Ocrevus when my liver recovered and have so far had no elevated LFTs. I will definitely keep an eye on my results though.
One thing I often wonder about: I had glandular fever during my master's degree (about 7 years before MS diagnosis). In addition to the normal symptoms, I had a very tender right flank. The doc said it was hepatitis in response to glandular fever. I do wonder if this means I have a particularly sensitive liver -- if that's even a thing. Anyway, this MS-Selfie has reminded me about those times. Cheers for the explanation!
Hepatitis is an uncommon complication of IM. However, once recovered, the liver usually gets back to normal. Unlike the CNS, the liver has a remarkable ability to recover function.
This is very helpful thank you.
Could you add a list of symptoms for liver injury or diseases that we can reference? I only know eyes or skin looking yellow and nausea. Can we tell anything about liver health from stool colour? Mine are often tan coloured or very light brown.
For how long after taking the last Cladribine pill do I need to be concerned about liver issues? Y2 bloods at 6 months liver function panel was all in range.
Liver dysfunction often presents with fatigue, loss of appetite, weight loss, and jaundice (yellowing of the skin/eyes). Other common signs include swollen abdomen or legs, itchy skin, dark urine, pale stools, easy bruising, and confusion. These latter symptoms are due to liver failure and do not appear until advanced liver damage occurs.
Abnormal LFTs after being exposed to a drug associated with DILI are typically in the first 8-12 weeks, i.e. when the drug is around and induces an immune response due to the so-called hapten effect.
I don't see my blood results from the hospital unless I request them on a SAR. Recently I've been doing this so that I know what they are. I like this type of information because it comes from a trusted source and saves me searching the internet for an explanation that might be written in Medspeak, not something approaching English that I can understand and is tailored towards MS ifvsppli coThree months after starting Siponimod my ALT was 159. The acceptable range is given as 0 - 32, so effectively 5 x ULN. ALP was 158 and GGT was 111. If AST was measured it must have been normal as I haven't made a note of its value. Nobody said anything until I queried why my next monitoring blood test was early and was told they wanted to check my liver because it's results were a bit high last time. I think this request came in May but I didn't have the sample taken immediately. The results from the 11th June show that ALP and ALT had returned to normal and GGT was 49.
My next monitoring blood test should be at the end of February. Assuming they do measure AST, is it likely to be higher because of my knee replacement on 29th November?
The AST is not part of the LFT panel done on the NHS. AST is also released from muscle damage and hence is not specific for liver disease. It has to be requested separately.
In which case, I’m pretty sure they didn’t request it. I would have looked it up if it had been listed separately to see what it was.
1 am not able to understand all the values, but the alert to watch for liver damage and ask for teats is sound and useful. Mother of Hannah who had a baby September 9th. We miss you in practice.
Marie
Prof G, I have always been prone to having slightly higher lfts. My bmi is about 29 and they definitely seem to go down when I drop some weight. I’ve had a normal ultrasound and normal fibrosis blood panel. Here is a recent round
AST: 35
ALT: 62
ALP: 119
Would this alt of 62 spook a neurologist to start someone like me on fenebrutinib once it was approved? I figure I have between now and approval to shed some pounds and get these labs in line.
Very helpful prof G. Thank you so much. Will share this all back w my neurologist!
The upper limit of normal for ALT varies by country. The typical range cited for adults is 7-56 IU/L; males tend to have higher upper limits of normal (45-60 IU/L) than females (34-40 IU/L). An ALT of 62 is just above normal and not clinically significant if all the other tests for diseases of the liver have been excluded. This should not be a contraindication to starting a therapy with a potential hepatotoxicity. What is important is monitoring any change.
An ALP of 119 is normal.
Are AST and GGT part of the LFT routine tests at Barts?
I am asking as I only get the following markers on my tests:
Bilirubin
Total protein
Albumin
Globulin
ALP
ALTl
No, these are not part of the routine LFT panel and have to be requested separately.
I am getting my liver looked at because my GGT and my ALT are elevated and I had no idea before doing the blood work for MS. I hope I can get it back into acceptable levels to be able to take medication. I was tested for Hepatitis and I don’t have it.
You need more investigations than just excluding hepatitis. Do you know what type of hepatitis was tested for? There are several viruses that infect the liver. Keep us posted on the outcome.