From the Research
Yes, a hepatic profile or liver function test (LFT) is indicated in AQP4-positive neuromyelitis optica spectrum disorder (NMOSD) patients, particularly when initiating and monitoring immunosuppressive treatments. Most first-line treatments for NMOSD, including azathioprine, mycophenolate mofetil, and rituximab, can potentially cause hepatotoxicity, as seen in studies such as 1 where azathioprine was used to treat AQP4-Ab NMOSD patients. Regular monitoring of liver function is essential, typically recommended before starting treatment and then every 3-6 months during therapy, or more frequently if abnormalities are detected. For azathioprine specifically, LFTs should be checked more frequently during the first few months of treatment. This monitoring is crucial because early detection of liver dysfunction allows for timely dose adjustments or medication changes before serious liver damage occurs. Additionally, NMOSD patients may have comorbidities or take other medications that affect liver function, making baseline and follow-up hepatic profiles important components of comprehensive care. The hepatic profile typically includes measurements of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, bilirubin, and albumin. Some studies, such as 2, have shown the effectiveness of glucocorticoids bridging rituximab in NMOSD patients, but the potential hepatotoxicity of these treatments further emphasizes the need for regular LFT monitoring. In the context of AQP4-positive NMOSD, the most recent and highest quality study, 2, although focused on the effectiveness and safety of glucocorticoids bridging rituximab, indirectly supports the importance of monitoring liver function due to the potential side effects of immunosuppressive treatments. Therefore, based on the strongest and most recent evidence, regular hepatic profiling is a critical component of managing AQP4-positive NMOSD patients on immunosuppressive therapies.