Use of Tumor Necrosis Factor-alpha Inhibitors in Patients with Chronic Hepatitis B Infection

[Guest guest]

Semin Arthritis Rheum. 2008 Jan 24. [Epub ahead of print]

Use of Tumor Necrosis Factor-alpha Inhibitors in Patients with Chronic Hepatitis

B Infection.

Carroll MB, Bond MI.

San Uniformed Services Health Education Consortium (SAUSHEC), Wilford

Hall Medical Center, Lackland Air Force Base, Lackland, Texas.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-alpha) inhibitors have emerged as a

potent treatment for rheumatoid arthritis (RA), but not without significant

risks. In chronic hepatitis B viral infection TNF-alpha is readily produced, and

viral clearance is dependent on the amount bioavailable. Limited data suggest

that TNF-alpha inhibitors may facilitate uncontrolled hepatitis B viral

replication. The purpose of this article was to provide a detailed review of the

role of TNF-alpha in controlling hepatitis B viral infection and the clinical

impact blockade might have on viral control. METHODS: We describe a patient with

chronic hepatitis B viral infection and RA treated with etanercept. We then

review case reports, expert opinion, and manufacturer recommendations regarding

hepatitis B viral infection, TNF-alpha, and TNF-alpha inhibitors. RESULTS: To

date, 13 patients with chronic hepatitis B infection treated with TNF-alpha

inhibitors have been reported: 11 with infliximab and 2 with etanercept. Some

patients received antiviral therapy for hepatitis B (specifically lamivudine)

before, during, or after TNF-alpha inhibitors were started. Clinically apparent

reactivation of hepatitis B virus typically occurred 1 month after the 3rd dose

of infliximab. Etanercept was not associated with a similar reactivation. The

difference between infliximab and etanercept in viral reactivation may be linked

to the pharmacologic difference of each medication. CONCLUSIONS: TNF-alpha

inhibitors in general should be used cautiously in chronic hepatitis B viral

infection. But if necessary, when deciding which agent to use, the clinician

should consider the mechanism by which the body clears TNF-alpha.

PMID: 18221983 [PubMed - as supplied by publisher]