Cimzia and my liver

I got a call on Friday from my Rheumatologist’s office that my insurance had approved me to start on Cimzia. My doctor wanted to try this one first because she said they do the injections in office instead of me doing them at home, I was a little disappointed because I wanted to do Enbrel first because it’s been around the longest. Anyway, they want me to come in as soon as possible to start.

But, I’m lao being looked at my a cardiologist currently (really bad costochondritis but being 100% sure to rule anything else out). My cardiologist looked over my blood work and was really concerned about my liver function. She wants me to see a hepatologist or at least a gastroenterologist before I start a biologic. She said liver failure is a real concern. My Rheumatologist didn’t seem concerned about my elevated liver function, she said it wasn’t that high and we just need to monitor it.

Has anyone else had any liver issues with Cimzia? Now I’m scared we’re going to get my PsA managed and then my liver will fail. I’m seeing a gastroenterologist on January 9th and I haven’t called my rheumatologist back yet.

Any feedback would be very appreciated!

Aw Bluebell, it’s always something, isn’t it?!

One thing I’m almost sure of is Enbrel does not harm the liver. I don’t know whether or not Cimzia does. So, if you need an argument for Enbrel…

I’ve never had elevated liver numbers with Enbrel and I don’t get extra lab tests being on it. I know some of the other meds–DMARDS, etc., can damage the liver.

Sorry you’re having to worry about this! I hope it all works out ok!

That’s so confusing for you. Are you taking Methotrexate or Leflunomide alongside Cimzia by any chance? Those drugs often cause elevated liver enzymes but it can very often be resolved by lowering the dose, having a break from them or trying a different traditional DMARD.

Because of the Mtx / Leflunomide effect, rheumys must see elevated liver enzymes very frequently. So the fact that your rheumy isn’t too concerned seems comforting. But against that, obviously, your cardiologist is concerned. One of them must be right, but which one? Sorry, I’m just repeating your words really, but with the rider that it may well be your rheumy who is on the money, I hope so!

I’d recommend phoning your rheumy back ASAP to get the clarification ball rolling.

I should mention that I have never taken Cimzia but I have had raised ALT for nigh on a year. I stopped Mtx, the levels gradually went down and I eventually had a liver scan that showed my liver to be fine. And then when I started Mtx again at a slightly lower dose the levels remained normal and have been perfectly okay for a few years now.

The only medication I am on so far is a low dose (25 mg) of idomethacin daily. I am on various other medications for other things though. My rheumatologist wants to jump right to a biologic because of my liver enzymes. She doesn’t want to risk methotrexate or a DMARD. My instinct is to trust the rheumatologist over the cardiologist but I want to make sure I’m as healthy as I can be going on to such a strong medication.


Hi Bluebell, this is what livertox at the NIH says;

“Certolizumab has been associated with a low rate of serum aminotransferase elevations during therapy, similar to the rate found with placebo therapy. The ALT elevations have been transient, mild and asymptomatic, and have rarely required dose modification. Certolizumab has been available for a relatively short period of time, and case reports of clinically apparent hepatic injury due to its use have not been published. Nevertheless, it is likely that certolizumab, like infliximab and adalimumab, is capable of inducing clinically apparent liver injury that resembles autoimmune hepatitis, which generally arises after at least 3 months of use and is associated with a hepatocellular pattern of serum enzyme elevation and autoantibody formation. Autoimmune hepatitis induced by anti-TNFα blocking agents can be severe and self-sustained and require corticosteroid therapy.”

So it seems that Cimzia, can, in theory, trigger an autoimmune response in the liver (as with any TNF-a antagonist), but there are few, if any, reports of it yet.

I agree it is worth talking to your Rheumy - it may be worth considering whether your cardiologist has factored in all the co-morbidities of untreated PsA, or he thinks perhaps it’s just sore joints? After all, it’s reasonable to expect other specialists may not be aware of the myriad of systemic risks.

1 Like

Thanks for that! It definitely makes me feel better.

But, I do think the cardiologist is more aware of what the disease is than other doctors I have had. She told me her suspicion anything was wrong with my heart was low but that I was at increased risk of heart disease with any inflammatory arthritis and she said she was going to put some sort of flag on my record.

I feel like everyday there is something new to panic about. It’s no wonder I’m having anxiety attacks daily.

Hi there Bluebell… It’s reassuring to hear that your cardiologist seems to be well aware of the potential issues from inflammatory arthritis. Yes, it is always wise to check things out thoroughly just as a precaution, better to check it out and find nothing than to ignore it and allow anything to get out of hand.

I’m not surprised you are having regular anxiety attacks… it’s a lot to take in!!! For some, ignorance is bliss… but for me personally I find the less I know about something the more inclined I am to panic about it… learning and understanding as much as I can helps to reduce anxiety levels when something new comes up, as does feeling supported by those who have understanding and knowledge in the field… I have found this forum immensely helpful on both scores.

As for starting the Cimzia, I completely understand your caution here… and don’t suppose waiting just a few more days to see your gastroenterologist will do any harm…

I also agree with @Sybil too… it seems your rheumy is knowledgeable and definitely keen to get the ball rolling on what she feels will be the safest and most appropriate medication for you right now… a phone call to the rheumy’s office might help you to determine the best course of action ie. wait till other potential issues are ruled out, or start on the Cimzia straight away… it does sound as if your rheumy will want to do what’s best for you!!

All the best with everything!! Please do let us know how it all goes!!

Here’s to 2018 proving to be an excellent year for you!!

My enzymes went up slightly while on Methotrexate, they watched for 6 months and then ordered a liver biopsy which was fine.
I am on Cimzia now, and my slightly elevated enzymes are no longer a concern. I don’t think it effects the liver as much.
With that said, you need to be your own advocate in this game called treatment. If something worries you
Ask questions, and keep asking until you feel safe.

I’m probably going to end up getting a biopsy. My latest test show my liver much more elevated…ugh

But my sed rates and my crp are much, much lower! Guess everything is a trade off, right?