From the Research
Yes, multiple sclerosis (MS) medications can cause hypoalbuminemia and elevated alkaline phosphatase levels, as evidenced by the most recent and highest quality study available 1.
Medications Involved
- Interferon beta medications (like Avonex, Rebif, and Betaseron) may cause liver function abnormalities including decreased albumin and altered alkaline phosphatase.
- Teriflunomide (Aubagio) and fingolimod (Gilenya) have been associated with liver enzyme elevations that can affect these values.
- Dimethyl fumarate (Tecfidera) may also impact liver function tests.
Mechanism and Monitoring
The mechanism involves medication metabolism through the liver, which can stress hepatic function and alter protein synthesis (affecting albumin) and enzyme production (affecting alkaline phosphatase) 1. Regular blood monitoring is recommended when starting these medications, particularly during the first 3-6 months 2, 3.
Clinical Implications
If significant changes in these values occur, dose adjustment or medication change may be necessary 4. These laboratory abnormalities often resolve with continued treatment or after discontinuation of the medication. However, in rare cases, liver injury can be severe, and clinicians should be aware of the potential risks and monitor patients closely 1, 4.
Key Considerations
- Patients with MS should be informed about possible hepatic side effects of their treatment 1.
- Concomitant use of hepatotoxic drugs should be avoided or closely monitored 3.
- Screening for hepatitis B and C virus is required before starting treatment with certain MS medications, and a monitoring or antiviral prophylaxis schedule has been established 1.