#3-13E. Unveiling a Class Effect: Histological Evidence of Certolizumab-Induced Autoimmune-Like Hepatitis (BMJ Case Rep, 2025)

How often do we consider the risk of autoimmune-like hepatitis when prescribing newer TNF-α inhibitors like certolizumab? This episode examines a pivotal 2025 case report involving a patient with psoriasis who developed severe liver dysfunction shortly after initiating therapy. The authors present the first detailed histological characterization of certolizumab-associated drug-induced autoimmune-like hepatitis (DI-ALH), revealing severe acute hepatitis with confluent necrosis that resolved solely upon drug withdrawal. The core clinical insight is the confirmation that DI-ALH is likely a class effect spanning all TNF-α antagonists, rather than being limited to older agents like infliximab or adalimumab. However, critical appraisal requires noting that this is a single case report without a confirmatory drug rechallenge, relying instead on temporal association and the exclusion of other etiologies. For clinicians, this study underscores the importance of monitoring liver function in patients on certolizumab and suggests that prompt discontinuation may be sufficient for recovery, potentially sparing patients from unnecessary long-term immunosuppression for misdiagnosed idiopathic autoimmune hepatitis.

Citation: Peggie E, Shetty S, Johnston M, et al. Certolizumab-associated autoimmune-like hepatitis. BMJ Case Rep. 2025. DOI: 10.1136/bcr-2025-266955

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.