Clinical

Infliximab may be safe in certain patients with viral hepatitis

Last Updated: 2004-02-27 12:45:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Infliximab, an anti-TNF-alpha antibody used for a variety of rheumatic diseases, is not recommended for patients with overt infectious diseases. But findings from a small case study suggest that the drug may be safe in patients with quiescent or controlled chronic viral hepatitis.

In a report published in the Journal of Rheumatology for January, Dr. Pascal Claudepierre and colleagues, from Hopital Henri Mondor in Creteil, France, describe two patients with chronic viral hepatitis who were successfully treated with infliximab.

The first case involved a 32-year-old man with chronic hepatitis B virus (HBV) infection and severe ankylosing spondylitis that had failed to respond several standard therapies. After achieving control of the HBV infection with lamivudine, the patient was started on infliximab.

The second case involved a 66-year-old woman with severe rheumatoid arthritis who was considered for infliximab therapy due to poor tolerance to methotrexate. During evaluation, the patient was found to have chronic hepatitis C virus (HCV) infection but without evidence of major histologic damage or liver test abnormalities.

In both patients, infliximab therapy produced a dramatic improvement in the joint disease. Moreover, neither patient experienced a worsening in liver function or virologic status.

"The two cases suggest that anti-TNF-alpha therapy may be effective and safe in some patients with severe inflammatory joint disease and chronic viral hepatitis," the investigators note. "Prospective studies with liver biopsies before, during, and after treatment cessation are now needed to validate this hypothesis."

J Rheumatol 2004;31:107-109.