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FDA Warns of Tysabri Liver Risk

Tysabri Linked to Possible Liver Damage; Drug Treats Multiple Sclerois and

Crohn's Disease

By Miranda Hitti

WebMD Medical News

Reviewed by Louise Chang, MD

Feb. 27, 2008 -- The FDA today announced that Tysabri, a drug used to treat

multiple sclerosis and Crohn's disease, has a new warning about possible risk of

liver injury.

Doctors should tell patients about the risk and stop Tysabri in patients with

jaundice or other signs (such as lab tests) of significant liver injury,

according to a letter sent to doctors by Tysabri's marketers, the drug companies

Biogen Idec and Elan.

Tysabri's new warning notes postmarketing reports of patients taking Tysabri who

developed liver injury, including markedly elevated blood levels of liver

enzymes and high levels of bilirubin. Bilirubin is made when red blood cells

break down. Too much bilirubin can cause jaundice.

Some of those patients experienced liver injury as early as six days after

starting Tysabri. Others developed liver injury later, after getting multiple

doses of Tysabri, which is a biologic drug given by health care professionals at

infusion centers.

Tysabri Timeline

The FDA first approved Tysabri in November 2004 for the treatment of multiple

sclerosis.

In February 2005, Biogen Idec and Elan took Tysabri off the market after three

people out of about 3,000 patients taking Tysabri in clinical trials developed a

rare, serious brain infection called progressive multifocal leukoencephalopathy

(PML). Two of those patients died.

In March 2006, researchers reported no new cases of PML in patients who took

Tysabri before the drug's suspension. An FDA panel unanimously recommends

returning Tysabri to the market.

In June 2006, the FDA allowed Tysabri back on the market under a restricted

distribution program -- and with a " black box " warning (the FDA's sternest

warning) about PML risk -- for the treatment of relapsing forms of multiple

sclerosis.

On Jan. 14, 2008, the FDA approved Tysabri for the treatment of Crohn's disease.

On Feb. 7, 2008, The New England Journal of Medicine published a letter from

researchers who noticed that two multiple sclerosis patients developed malignant

melanoma, a form of skin cancer, soon after starting Tysabri treatment. Both

patients had moles that became malignant after they started Tysabri treatment.

But it's not clear if Tysabri was responsible for that.

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