Infliximab as a treatment option for patients with rheumatoid arthritis and primary biliary cirrhosis

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease which commonly requires treatment with biologic agents targeting various inflammatory pathways. Tumor necrosis factor alpha is a proinflammatory cytokine which plays a pivotal role not only in the pathogenesis of RA but also in other autoimmune diseases such as primary biliary cirrhosis. The co-existence of more than one autoimmune disorder in the same individual is very challenging in the daily practice as therapy strategies applicable to one disease setting may cause clinical and/or biochemical relapse of the other clinical entity. As a result, treatment options able to control different diseases are highly desirable among rheumatologists and other specialties. In that respect, we present a case of a 61-year-old female patient with RA and concomitant primary biliary cirrhosis with poor clinical response to conventional disease-modifying drugs for RA. The introduction of tumor necrosis factor alpha antagonist infliximab led to significant clinical improvement of RA and to stabilization of liver function. In this case review study, we discuss aspects of pathophysiology of primary biliary cirrhosis associated with tumor necrosis alpha and we review the available data of similar published cases.

Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver

“…PBC is considered an immunologically mediated disease where the TNF-α plays a prominent pathogenic role [10]. The unique data published on the use of IFX in PBC are collected in patients with RA and PBC.…”

“…While TNF-α inhibitors are a well-established treatment option for RA, the experience of using such regimens when inflammatory arthritis coexists with PBC is inconclusive. Garyfallos et al [10] reported a case of a female patient with RA and concomitant PBC with poor clinical response to conventional treatment. IFX use led to a significant clinical improvement of RA and to the stabilization of liver function.…”

“…On the other hand, anti-TNF-α agents have also been used for treating the severe stages of hepatic diseases such as alcoholic hepatitis (AH) [7,8] and non-alcoholic fatty liver disease (NAFLD) [9]. Recently, anecdotal evidences of efficacy of anti-TNF-α agents as rescue therapy in difficult-to-treat autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) have been reported [10,11,12] (Table 1). …”

Rheumatoid arthritis associated with primary biliary cholangitis under treatment with biological drugs

“…tiene la particularidad de mostrar que los parámetros de CBP que habían mejorado con etanercept, empeoraron al suspenderlo y volvieron a mejorar al reintroducirlo 10 . otra paciente recibió infliximab y tras 24 meses las enzimas hepáticas permanecieron estables y normales 11 . Existe solo un caso reportado en Croacia (publicación sin referato) con adalimumab en el cual ambas enfermedades se mantuvieron en una larga remisión.…”

Identifying Infliximab- (IFX-) Responsive Blood Signatures for the Treatment of Rheumatoid Arthritis

“…IFX targets one of the pathogenic proinflammatory cytokines, tumor necrosis factor-alpha (TNF-α), and thus has been applied in classical TNF antagonist therapy against multiple chronic autoimmune inflammatory diseases, including RA [23]. The clinical application of IFX has been studied for nearly 30 years; IFX greatly improves physical functions and is beneficial for the achievement of clinical remission even under discontinuous medication [24,25]. However, not all patients react to IFX, and its anti-inflammatory effects vary among patients with RA.…”