Clinical

Infliximab for Crohn's disease may activate chronic hepatitis B

Last Updated: 2004-09-06 7:30:25 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Infliximab therapy for Crohn's disease may be associated with reactivation of chronic hepatitis B (HBV) infection, Spanish researchers report in the September issue of Gut.

In fact, lead investigator Dr. Maria Esteve from Hospital Universitari M�tua de Terrassa, Barcelona, told Reuters Health, "when possible, all patients with Crohn's disease should be vaccinated to avoid reactivation related to immunosuppression," particularly when being treated with infliximab.

Dr. Esteve and colleagues prospectively monitored hepatitis B and C markers and liver function test results in 80 Crohn's disease patients requiring infliximab infusion.

Three had chronic HBV infection at the time of the infusion. Two of these patients, a 34-year-old man and a 38-year-old man, experienced severe reactivation of chronic HBV months later. The 38-year-old patient died of HBV complications while awaiting liver transplantation.

No other patients showed significant changes in hepatic function. Only one patient had positive anti-hepatitis C virus (HCV) antibodies, the researchers note, but was HCV RNA negative and aminotransferase levels remained normal.

Given these findings, Dr. Esteve said that "careful monitoring of viral hepatitis infection is advised in Crohn's disease patients requiring immunosuppressives."

Moreover, "antiviral therapy--with lamivudine or adefovir dipivoxil--should be administered to those patients requiring infliximab therapy who exhibit positive surface antigen-HbsAg--with or without active viral replication."

Gut 2004;53:1363-1365.