CASE STUDIES - Use of TNF antagonists in patients with concurrent RA and HBV or HBC: a retrospective record review of 11 cases

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Clin Rheumatol. 2009 Mar 17.

Use of tumor necrosis factor-alpha (TNF-alpha) antagonists infliximab,

etanercept, and adalimumab in patients with concurrent rheumatoid

arthritis and hepatitis B or hepatitis C: a retrospective record

review of 11 patients.

Li S, Kaur PP, Chan V, Berney S.

Division of Rheumatology, Department of Medicine, School of Medicine,

Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA,

Sophia.

An understanding of the cytokine cascade in a rheumatoid joint has led

to the development of new therapeutic options, including drugs

targeting tumor necrosis factor-alpha (TNF-alpha). The safety profile

of these agents in patients with hepatitis-induced liver disease,

however, remains a concern because of risks associated with immune

suppression. To examine the effect of three different TNF-alpha

antagonists, infliximab, etanercept, and adalimumab, on serum

transaminases and hepatitis viral load in patients with rheumatoid

arthritis (RA) and concurrent hepatitis B (HBV) or hepatitis C (HCV).

Medical records of 11 patients with diagnosis of RA and documented

seropositivity for hepatitis B or hepatitis C were retrospectively

reviewed for worsening of hepatic inflammation and viral proliferation

as measured by a rise in aspartate aminotransferase (AST) or alanine

aminotransferase (ALT) and viral load while using these agents. Three

patients had RA with concurrent chronic HBV and eight patients had RA

with concurrent chronic HCV. Seven patients remained on a single

anti-TNF-alpha agent and four patients switched to a second

anti-TNF-alpha agent due to treatment failure. Two patients showed a

transient elevation in AST and/or ALT from normal, but in all 11

patients, AST and ALT levels were within one time the upper range of

normal at the conclusion of the study. No significant increase in

viral load was seen except one patient who showed a fourfold increase

from baseline. Our case series supports results obtained from previous

studies examining the safety of anti-TNF-alpha agents in patients with

underlying hepatic disease. Use of these agents in patients with HBV

or HCV may be associated with a transient transaminitis but appears to

be safe overall. In both groups, frequent monitoring of serum

transaminase levels and viral load is essential.

PMID: 19291350

http://www.ncbi.nlm.nih.gov/pubmed/19291350

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