RESEARCH - Use of TNF-alpha inhibitors in patients with chronic hepatitis B infection

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Semin Arthritis Rheum. 2008 Jan 24

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

http://www.ncbi.nlm.nih.gov/pubmed/18221983

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Not an MD