Effect of tumour necrosis factor   antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection

Abstract

Background: Tumour necrosis factor a (TNFa) 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 TNFa 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 TNFa 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 TNFa 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 TNFa antagonists merit further study for the treatment of RA in HCV infected patients. Larger and longer term studies are still needed.

Viral infection and reactivation in autoimmune disease

“…Evidence from clinical trials suggests that TNF inhibitors are not significantly associated with HCV reactivation. For example, in a study of HCV-infected patients with RA who were treated with infliximab or etanercept, there were no significant differences in liver function test results (n ϭ 24) or in HCV titers (n ϭ 22) from baseline to 34 months (48). In another study, 3 patients with RA and chronic HCV infection experienced no changes in liver enzyme levels or viral load following 6-39 months of TNF inhibitor therapy (49).…”

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

“…The case series suggest that anti-TNF therapy has no adverse effects and that it might even improve HCV infection. 29,[47][48][49][50][51][52][53][54][55][56] Some authors 57 found no significant differences in liver function or viraemia at baseline or during follow-up in HCV-infected patients receiving infliximab or etanercept for rheumatoid arthritis. Finally, etanercept improved virological response to combined interferon-a plus ribavirin in HCV-positive patients.…”

Biological Therapy and Infection in Rheumatoid Arthritis Patients: Modern Aspects

“…Показано, что ФНО-α может индуцировать продукцию бета-факто-ра трансформации роста, экспрессия которого тесно связана с гистологической выраженностью активности процесса и долькового некроза у больных с хронической HCV-инфекцией. Более того, высокие уровни ФНО-α ока-зывают негативное влияние на ответ макроорганизма больного HCV при терапии интерфероном [85]. Следовательно, блокирование ФНО-α могло бы иметь благоприятные последствия для больных с HCV-инфекцией.…”