Effect of Enbrel and Remicade on tansaminases and viraemia in patients with RA and chronic HCV

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ls of the Rheumatic Diseases 2003;62:1078-1082

© 2003 by

Effect of tumour necrosis factor antagonists on serum transaminases and

viraemia in patients with rheumatoid arthritis and chronic hepatitis C

infection

J R 1, F C Hsu1, P A Simkin1 and M H Wener1,2

1 Division of Rheumatology, University of Washington, USA

2 Department of Laboratory Medicine, University of Washington, USA

Correspondence to:

Dr M H Wener, Department of Laboratory Medicine, Box 357110, UWMC,

Seattle, WA 98195, USA;

wener@...

Background: Tumour necrosis factor (TNF) antagonists are effective for

the treatment of rheumatoid arthritis (RA), but concerns remain about

the safety of these agents in the presence of chronic infections,

including hepatitis C virus (HCV) infection.

Objective: To examine the influence of treatment with TNF antagonists on

levels of HCV viraemia and serum transaminases in patients with RA and

HCV.

Methods: In a retrospective survey the course of 16 HCV infected

patients with RA who had received the TNF antagonists etanercept or

infliximab was analysed. Eight additional patients with RA and HCV were

also enrolled into a three month prospective trial of etanercept. Serum

concentrations of albumin, alkaline phosphatase, aspartate

aminotransferase, alanine aminotransferase, and HCV were followed.

Results: Viraemia was measured in 22 patients receiving a TNF antagonist

at the start of treatment and after 1-34 months (median 9 months follow

up). Twenty four patients had serial tests of liver related enzymes and

albumin. None of the differences between liver related tests at baseline

and at follow up achieved significance (p>0.05). Similarly, the mean HCV

measurement at 1-3, 4-6, 7-12, and 13-34 months did not differ

significantly from baseline (p>0.05).

Conclusion: In this study, liver related blood tests and HCV viral load

measurements did not change substantially. These findings suggest that

TNF antagonists merit further study for the treatment of RA in HCV

infected patients. Larger and longer term studies are still needed.

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