Clinical

Reactivation rare in occult HBV carriers treated with TNF blockers

Last Updated: 2010-03-29 10:00:29 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Tumor necrosis factor (TNF)-alpha blockers are unlikely to reactivate hepatitis B virus (HBV) infection in HBV core-positive patients, as long as they are surface antigen (HBsAg)-negative.

This finding by Italian researchers was reported online February 12th in Arthritis Care & Research. The issue of HBV reactivation has been addressed before in patients who need cancer chemotherapy, but less is known about reactivation in HBV carriers with chronic inflammatory arthropathies, according to lead author Dr. Roberto Caporali from University of Pavia and colleagues.

Their paper describes 67 patients - 59 with rheumatoid arthritis, 4 with psoriatic arthritis, and 4 with ankylosing spondylitis - who received anti-TNF-alpha therapy. All were HBV core positive and HBsAg-negative.

At a mean follow-up of 43 months, none of the patients had become HBsAg-positive, and none had detectable HBV DNA during the study, indicating a complete absence of HBV reactivation.

Thirty-four patients had aminotransferase elevations, which were transient in all but one. In 28 patients, enzymes spontaneously normalized within three weeks. In another five, levels returned to normal within a month after withdrawal of methotrexate or nonsteroidal anti-inflammatory drugs. The remaining patient had persistent aminotransferase elevation along with an increase in hepatitis C viremia.

The only changes in the final liver profile were the appearance of anti-HBs in five patients and anti-HBe in two patients.

The authors note that 25 patients took infliximab, 23 took etanercept, and 19 took adalimumab. In addition, 51 took methotrexate, 52 took NSAIDs, and 43 received prednisone.

They checked patients' liver enzymes every two months and HBV markers and HBV DNA every six months (or more often if enzymes were high).

"Our data, showing a very low risk of viral reactivation in a large cohort of patients, may be helpful in defining the optimal monitoring strategy in potential occult HBV carriers treated with long-term anti-TNF-alpha therapy for rheumatic diseases," the researchers conclude.

Arthritis Care Res 2010.