Clinical

Anti-TNF therapy may be safe for patients with hepatitis C

Last Updated: 2004-11-10 15:24:42 -0400 (Reuters Health)

By Karla Gale

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 efficacious."

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.