Safety of anti-TNF alpha treatment in rheumatic patients with chronic hepatitis B or C

Authors: O. Šléglová;  Z. Mareček 1;  P. Urbánek 1;  K. Pavelka
Authors‘ workplace: Revmatologický ústav Praha ;  Interní klinika ILF UK a ÚVN Praha 1
Published in: Čes. Revmatol., 15, 2007, No. 2, p. 105-111.
Category: Overview Reports


Administration of tumor necrosis factor alpha inhibitors (anti-TNF alpha) represents an immense progress in the treatment of inflammatory rheumatic diseases. However, it associates with increased risk of infections. The authors emphasize the possibilities of hepatitis B virus reactivation during anti-TNF alpha treatment, which caused serious complications in several cases. Therefore screening for hepatitis B before the initiation of the treatment is necessary. Anti-TNF alpha treatment could be safe in patients with chronic hepatitis B, when treatment with lamivudin or adefovir prior to anti-TNF alpha is started. Careful monitoring of liver enzymes and viraemia during this treatment is necessary. Different situation is in patients with hepatitis C. Anti-TNF alpha treatment is safe in patients with chronic hepatitis C, however screening for hepatitides, and careful monitoring of liver enzymes and viraemia during the treatment is also necessary. One of the presented study shows that combination of standard antiviral treatment of hepatitis C and anti-TNF alpha may increase the chance to suppress viral replication early. More vigilance is necessary to the issue of anti-TNF alpha treatment of patients with hepatitis B or C and further studies on coincidence of those diseases are anticipated.

Key words:
anti-TNF alpha treatment, hepatitis B, hepatitis C, inflammatory rheumatic diseases


1. Desai SB, Furst SE. Problems encountered during anti-tumour necrosis factor therapy. Best Pract. Rese. Clin Rheumatol 2006; 20: 757–790.

2. Calabrese LH, Zein NN, Vassilopoulos D. Hepatitis B virus reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies. Ann Rheum Dis 2006; 65: 983–989.

3. Frank AP, Reveille JD. Anti-tumor necrosis factor agents for rheumatoid arthritis in the setting of chronic hepatitis C infection. Arthritis Rheum 2004; 51: 800–804.

4. Urbánek P, Husa P, Kumpel P, Šperl J. Doporučení české hepatologické společnosti pro diagnostiku a léčbu chronické hepatitidy C. Vnitřní lékařství 2005; 51: 1131–1137.

5. Calabrese LH, Zein NN, Vassilopoulos D. Safety of anti tumor necrosis factor therapy in patients with chronic viral infections: hepatic C, hepatitis B, and HIV infection. Ann Rheum Dis 2004; 63: 18–24.

6. Tilg H, Kaser A, Moschen AR. How to modulate inflammatory cytokines in liver diseases. Liver International 2006; 26: 1029–1039.

7. Campbell S, Ghosh S. Infliximab therapy for Crohn’s disease in the presence of chronic hepatitis C infection. Eur J Gastroenterol Hepatol 2001; 13: 191–2.

8. Peterson JR, Hsu FC, Simkin PA, Wener MH. Effect of tumor necrosis necrosis factor alpha antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis 2003; 62: 1078–82.

9. Parke FA, Reveille JD. Anti-tumor necrosis factor agents for rheumatoid arthritis in the setting of chronic hepatitis C infection. Arthritis Rheum 2004; 51: 800–4.

10. Magliocco MA, Gottlieb AB. Etanercept therapy for patients with psoriatic arthritis and concurrent hepatitis C virus infection: report of 3 cases. J Am Acad Dermatol 2004; 51: 580–4.

11. Roux CH, Brocq O, Breuil V, Albert C, Euller-Ziegler L. Safety of anti-TNF-α therapy in rheumatoid arthritis and spondylarthropathies with concurrent B or C chronic hepatitis. Rheumatology 2006; doi: 10.1093/rheumatology/kel123.

12. Zein NN. Etanercept as an adjuvant to interferon and ribavirin in treatment-naive patients with chronic hepatitis C virus infection: a phase 2 randomized, double blind, placebo-controlled study. J Hepatol 2005; 42: 315–22.

13. Husa P, Plíšek S, Šperl J, Urbánek P, Galský J, Hůlek P, Kumpel P, Němeček V, Volfová M. Diagnostika a léčba chronické hepatitidy B. Doporučený postup ČHS a SIL ČSL JEP. Klin mikrobiol inf lék 2005; 11: 138–143.

14. Pernillo RP. Acute flares in chronic hepatitis B: the natural and unnatural history of an immunologically mediated liver disease. Gastroenterology 2001; 120: 1009–22.

15. Cheng AL, Hsiung CA, SU U, Chen PJ, Chang MC, Tsao CJ, et al. Steroid-free chemotherapy decreases risk of hepatitis B virus reactivation in HBV-carriers with lymphoma. Hepatology 2003; 37: 1320–8.

16. Ostuni P, Botsios C, Punzi L, Sfriso P, Todesco S. Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexat. Ann Rheum Dis 2003; 62: 686–7.

17. Michel M, Duvoux C, Hezode C, Cherqui D. Fulminant hepatitis after infliximab in a patient with hepatitis B virus treated for an adult onset still’s disease. J Rheumatol 2003; 30: 1624–5.

18. Esteve M, Saro C, Gonzalez-Huix F, Suarez F, Forne M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis. Gut 2004; 53: 1363–5.

19. Wendling D, Auge B, Bettinger D, et al. Reactivation of a latent precore mutant hepatitis B virus related chronic hepatitis during infliximab treatment for severe spondylartropathy. Ann Rheum Dis 2005; 64: 788–9.

20. Millonig G, Kern M, Ludwiczek O, Nachbaur K, Vogel W. Subfulminant hepatitis B after infliximab in Crohn’s disease: Need for HBV-screening? World J Gastroenterol 2006; 12: 974–6.

21. Flowers MA, Heathcote J, Wanless IR, Sherman M, Reynolds WJ, Cameron RG, et al. Fulminant hepatitis as a consequence of reactivation of hepatitis B virus infection after discontinuation of low-dose methotrexate therapy. Ann Intern Med 1990; 112: 381–2.

22. Hagiyama H, Kubota T, Komano Y, Kurosaki M, Watanabe M, Miyasaka N. Fulminant hepatitis in an asymptomatic chronic carrier of hepatitis B virus mutant after withdrawal of low-dose methotrexate therapy for rheumatoid arthritis. Clin Exp Rheumatol 2004; 22: 375–6.

23. Silvestri F, Ermacora A, Sperotto A, Patriarca F, Zaja F, Damiani D, et al. Lamivudine allows completion of chemoterapy in lymphoma patients with hepatis B reactivation. Br J Haematol 2000; 108: 394–6.

24. Rossi G. Prophylaxis with lamivudine of hepatitis B virus reactivation in chronic HBsAg carriers with hemato-oncological neoplasis treated with chemotherapy. Leuk Lymphoma 2003; 44: 759–66.

Dermatology & STDs Paediatric rheumatology Rheumatology
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