Reuters Health Information (2004-11-10): Anti-TNF therapy may be safe for patients with hepatitis C
Anti-TNF therapy may be safe for patients with hepatitis C
Last Updated: 2004-11-10 15:24:42 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Patients with chronic
hepatitis C (HCV) infection can apparently take anti-tumor necrosis
factor (TNF) agents as treatment for rheumatoid arthritis (RA) without
causing persistently elevated liver enzymes, physicians at the
University of Texas-Houston Health Science Center report.
There is a concern that immune suppression resulting from anti-TNF
therapy could be deleterious to the health of patients with HCV, Drs.
Frank A. Parke and John D. Reveille note in their paper, published in
the October 15th issue of Arthritis and Rheumatism. On the other hand,
evidence suggests that HCV pathogenesis may be mediated by upregulation
of TNF-alpha and other cytokines, so in theory, anti-TNF therapy may be
of benefit for these patients.
For this study, the authors reviewed the charts of five patients
with HCV and RA undergoing treatment with infliximab or etanercept.
During an average follow-up of 41 months, patients did not develop
jaundice or clinical manifestations of hepatic insufficiency, the
authors write. There were no sustained elevations in aspartate
aminotransferase and alanine aminotransferase levels.
HCV load varied among the patients. One patient showed a linear
decrease in viral load over approximately 2 years, whereas just one
displayed an exponential rise over approximately 15 months.
"I don't let a person's HCV status determine whether or not we will
give them a TNF blocker, because it does not seem to be an issue," Dr.
Reveille told Reuters Health.
"The same thing holds true for patients with HIV and RA, so long as
their HIV is well controlled," he added. "In that setting there is no
worsening of the disease and the drugs are well tolerated and
But, Dr. Reveille indicated, "if you anticipate using these drugs
for patients with HIV or HCV, you should monitor them closely for
evidence of disease reactivation and for evidence that the patient is
not doing badly with the disease up front, because in those situations
it's a little more dangerous."
Arthritis Rheum 2004;51:800-804.