Re: CASE STUDY - Use of TNF inhibitors in patients with chronic HBV infection

[Guest guest]

, thank you for this article...

Raniolo

From: <Rheumatoid.Arthritis.Support@...>

Subject: [ ] CASE STUDY - Use of TNF inhibitors in patients with

chronic HBV infection

" " < >

Date: Tuesday, May 19, 2009, 11:54 AM

Semin Arthritis Rheum. 2008 Dec;38(3):208- 17. Epub 2008 Jan 25.

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,

USA.

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

Not an MD