Clinical

TNF-alpha blockers safe for RA patients with HCV infection

Last Updated: 2008-10-23 15:23:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Anti-tumor necrosis factor (TNF)-alpha therapy does not seem to exacerbate hepatitis C virus (HCV) infection in patients with active rheumatoid arthritis (RA), with the benefits of treatment outweighing the risks, Italian researchers say.

In the October issue of The Journal of Rheumatology, Dr. Clodoveo Ferri, of University of Modena and Reggio Emilia, and colleagues with the GISEA Group describe their study in 31 patients, all of whom had active RA and Disease Activity Score 28 (DAS28) greater than 3.2 and were unresponsive to conventional RA therapies. In addition, all patients had HCV infection with a mean duration of 13 years.

Patients were given standard doses of TNF-alpha blockers, including infliximab, etanercept or adalimumab. Safety and efficacy were assessed after three months of treatment and at the patient's last observation.

Significant clinical and serological improvements were observed after three months of treatment, Dr. Ferri and colleagues report. Mean erythrocyte sedimentation rate fell from 36 to 28 mm/hour. DAS28 decreased from 5.2 at baseline to 2.78 at three-month follow-up. DAS28 scores below 2.6 were recorded in 15/31 (48%) patients at follow-up.

Furthermore, patients' assessment of their general health improved, with scores on the 100-point visual analog scale decreasing from 69 to 35 and on the Ritchie index from 21.6 to 10.1.

At the last observation, 19/31 patients (61%) continued TNF-alpha blocker therapy, and the observed benefits persisted after an average 22 months of follow-up.

Mean transaminase levels and HCV viral load showed no significant variations, according to the researchers. HCV viremia increased significantly in 4 cases (i.e., at least 2 log10).

TNF-alpha blocker therapy was stopped in only one patient because of persistently elevated alanine aminotransferase (ALT) values that were not associated with HCV viremia.

"Given the clinical-therapeutic implications, our results support the safety of TNF-alpha blockers in patients with HCV, provided there is close monitoring of clinical and virological data (mainly ALT and HCV viremia)," the Italian team concludes.

J Rheum 2008;35:1944-1949.