Chronic hepatitis E in a patient with rheumatoid arthritis treated with adalimumab and methotrexate

Bijnen, Sandra T. A. van; Ledeboer, M.; Martens, Henk A.

doi:10.1093/rheumatology/kew388

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…National primary care treatment guidelines in European countries recommend fusidic acid, mupirocin, or retapamulin as topical treatments for impetigo [21]. However, the development and spread of staphylococcal strains resistant to these agents is a concern.…”

Section: Discussionmentioning

confidence: 99%

Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents

Torrelo

Grimalt

Masramon³

et al. 2020

Dermatology

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Background: Ozenoxacin is a topical antibiotic approved in Europe to treat non-bullous impetigo in adults and children aged ≥6 months. This analysis evaluated the efficacy and safety of ozenoxacin in paediatric patients by age group. Methods: Pooled data for patients aged 6 months to < 18 years who had participated in a phase I or in two phase III clinical trials of ozenoxacin 1% cream were analysed by age group: 0.5-< 2, 2-< 6, 6-< 12, and 12-< 18 years. Results: The combined population comprised 529 patients with non-bullous impetigo treated with ozenoxacin (n = 239), vehicle (n = 201), or retapamulin as internal validation control (n = 89). Studies were well matched for extent and severity of impetigo and therapeutic schedule (twice daily application for 5 days). The clinical success rate after 5 days' treatment (day 6-7, end of therapy), and microbiological success rates after 3-4 days' treatment and at the end of therapy, were significantly higher with ozenoxacin than vehicle (p < 0.0001 for all comparisons). Clinical and bacterial eradication rates were higher with ozenoxacin than vehicle in each age group. No safety concerns were identified with ozenoxacin. One (0.3%) of 327 plasma samples exceeded the lower limit of quantification for ozenoxacin, but the low concentration indicated negligible systemic absorption. Conclusion: This combined analysis supports the efficacy and safety of ozenoxacin administered twice daily for 5 days. Ozenoxacin 1% cream is a new option to consider for treatment of non-bullous impetigo in children aged 6 months to < 18 years.

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Section: Discussionmentioning

confidence: 99%

Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents

Torrelo

Grimalt

Masramon³

et al. 2020

Dermatology

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“…The case reports of hepatitis E infection in patients with RA are accumulating [ 12 – 21 ]. Table 2 summarizes published cases of hepatitis E developed during the treatment of RA with DMARDs.…”

Section: Discussionmentioning

confidence: 99%

“…The HEV genotype detected in this patient was genotype 4, which is known to be more virulent than genotype 3. In addition, a male patient (case 25) who was administered adalimumab and methotrexate developed chronic hepatitis E [ 21 ]. The routine testing revealed elevated liver enzyme levels, and methotrexate, but not adalimumab, was discontinued.…”

Section: Discussionmentioning

confidence: 99%

“…Eight months later, he was diagnosed with HEV infection, and adalimumab was discontinued. However, serum HEV RNA remained positive for more than 5 months; therefore, he was treated with ribavirin for 42 days until the test results for serum HEV RNA were negative [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with RA who are treated with DMARDs as listed above, only 4 cases were treated with ribavirin and 3 of them had been treated with rituximab. Another patient had been treated with adalimumab before and after notification of elevated liver enzymes for several months and ultimately developed chronic hepatitis E, as described above [ 14 , 15 , 19 , 21 ]. Based on these results, antiviral therapy may be considered only in high-risk patients: patients with HEV (genotype 4), those who had been treated with long-lasting and immunosuppressive DMARDs such as rituximab, and those with severe or chronic hepatitis.…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Ikeuchi

Koinuma

Nakasatomi

et al. 2018

Case Reports in Rheumatology

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Hepatitis E is an acute self-limiting disease caused by hepatitis E virus (HEV). Recent reports show that HEV can induce chronic hepatitis or be reactivated in immunocompromised hosts. We report a 63-year-old woman with rheumatoid arthritis (RA) who developed hepatitis E during treatment with tocilizumab. Analysis of serially stocked serum samples confirmed that hepatitis was caused by primary infection with HEV and not by viral reactivation. Her liver function improved after discontinuing tocilizumab and remained within the normal range without reactivation of HEV for >5 years after restarting tocilizumab. We also reviewed the published cases of hepatitis E that developed during RA treatment.

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Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19

Lampejo

Curtis

Ijaz³

et al. 2022

Journal of Clinical Virology

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Background Transmission of hepatitis E virus (HEV) within the healthcare setting is extremely rare. Additionally, the development of chronic HEV infection in association with severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection and/or its immunomodulatory therapy has not been reported previously. Aims To describe the investigation and management of a nosocomial HEV transmission incident during the coronavirus disease 2019 (COVID-19) pandemic. Methods Epidemiological and molecular investigation of two individuals hospitalised with COVID-19 who were both diagnosed with HEV infection. Results Findings from our investigation were consistent with transmission of HEV from one patient with a community-acquired HEV infection to another individual (identical HEV sequences were identified in the two patients), most likely due to a breach in infection control practices whilst both patients shared a bed space on the intensive care unit (ICU). Chronic HEV infection requiring treatment with ribavirin developed in one patient with prolonged lymphopaenia attributable to COVID-19 and/or the immunomodulators received for its treatment. Further investigation did not identify transmission of HEV to any other patients or to healthcare workers. Conclusions The extraordinary demands that the COVID-19 pandemic has placed on all aspects of healthcare, particularly within ICU settings, has greatly challenged the ability to consistently maintain optimal infection prevention and control practices. Under the significant pressures of the COVID-19 pandemic a highly unusual nosocomial HEV transmission incident occurred complicated further by progression to a chronic HEV infection in one patient.

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Chronic hepatitis E in a patient with rheumatoid arthritis treated with adalimumab and methotrexate

Cited by 5 publications

References 6 publications

Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents

Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents

Hepatitis E during Tocilizumab Therapy in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19

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