The Influence of Anti-TNF Therapy on the Course of Chronic Hepatitis C Virus Infection in Patients with Inflammatory Bowel Disease

Lin, Ming V.; Błoński, Wojciech; Buchner, Anna M.; Reddy, K. Rajender; Lichtenstein, Gary R.

doi:10.1007/s10620-012-2457-0

“…Lastly, in 5 patients an increase of transaminases did not correspond to increased viremia and liver biopsy was not performed [24]. After this review, other studies including a small series of patients were published, confirming the previous findings on the acceptable safety profile of this class of drugs in case of concurrent HCV-infection [25,26,27,28,29,30]. …”

Section: Chronic Viral Hepatitissupporting

confidence: 64%

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

Lopetuso

¹

,

Mocci

²

,

Marzo

³

et al. 2018

IJMS

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Anti-tumor necrosis factor (TNF)-α agents represent an effective treatment for chronic inflammatory diseases. However, some concerns about their potentially undesirable effects on liver function have been reported. On the other hand, evidence of their therapeutic effects on certain liver diseases is accumulating. Many data showed the safety of anti-TNF-α in patients with chronic hepatitis B and C and in liver transplanted patients even if a strict follow-up and prophylaxis are recommended in well-defined subgroups. On the other side, anti-TNF-α-induced liver injury is not a rare event. However, it is often reversible after anti-TNF-α withdrawal. Anti-TNF-α agents have been tested in advanced stages of severe alcoholic hepatitis and non-alcoholic fatty liver disease. Limited data on the efficacy of anti-TNF-α in patients with autoimmune hepatitis and primary biliary cholangitis are also available. In this review, we explored the hepatic safety concerns in patients receiving anti-TNF-α agents with and without pre-existent hepatic diseases. In addition, the available evidence on their potential benefits in the treatment of specific hepatic diseases is discussed.

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“… PICO E.1. The recommendation is conditional because the evidence is of very low quality, i.e., indirect evidence from patient populations other than RA . The evidence suggests that these RA patients with hepatitis C virus (HCV) infection should not be treated differently than RA patients who do not have hepatitis C. The Voting Panel recommended that rheumatologists collaborate with gastroenterologists and/or hepatologists to monitor patients receiving antiviral therapy.…”

Section: Results/recommendationsmentioning

confidence: 99%

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Singh

¹

,

Saag

²

,

Bridges

³

et al. 2015

Arthritis Care & Research

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Objective To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA). Methods We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. Results The guideline covers the use of traditional disease‐modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat‐to‐target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. Conclusion This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision‐making process taking into account patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

show abstract

“… PICO E.1. The recommendation is conditional because the evidence is of very low quality, i.e., indirect evidence from patient populations other than RA . The evidence suggests that these RA patients with hepatitis C virus (HCV) infection should not be treated differently than RA patients who do not have hepatitis C. The Voting Panel recommended that rheumatologists collaborate with gastroenterologists and/or hepatologists to monitor patients receiving antiviral therapy.…”

Section: Results/recommendationsmentioning

confidence: 99%

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Singh

¹

,

Saag

²

,

Bridges

³

et al. 2015

Arthritis & Rheumatology

View full text Add to dashboard Cite

Objective To develop a new evidence‐based, pharmacologic treatment guideline for rheumatoid arthritis (RA). Methods We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. Results The guideline covers the use of traditional disease‐modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat‐to‐target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. Conclusion This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision‐making process taking into account patients’ values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

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The Influence of Anti-TNF Therapy on the Course of Chronic Hepatitis C Virus Infection in Patients with Inflammatory Bowel Disease

Cited by 23 publications

References 38 publications

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

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

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

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