J Rheum Dis.  2018 Apr;25(2):108-115. 10.4078/jrd.2018.25.2.108.

Transaminase Changes in Korean Rheumatoid Arthritis Patients with Chronic Hepatitis C after Biologic Therapy

• Kwon HM
• Shin K
• Moon JY
• Lee SS
• Chung WT
• Lee J
• Lee SH
• Kang SW
• Suh CH
• Hong SJ
• Song R
• Choe JY
• Song YW

• KMID: 2408928
• DOI: http://doi.org/10.4078/jrd.2018.25.2.108

Abstract

OBJECTIVE
Coexisting chronic hepatitis C can be problematic when treating rheumatoid arthritis (RA). This study examined the changes in the transaminase and viral load in hepatitis C virus (HCV)-infected RA patients after initiating biologic agents.
METHODS
A multicenter retrospective study was conducted at 12 University Hospitals in Korea between November 2014 and November 2015, and 78 RA patients, who met the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA and were concomitantly infected with HCV, were identified. The baseline and longitudinal clinical data, changes in liver function, and viral RNA titers were evaluated.
RESULTS
Seventeen (21.8%) patients were treated with biologic agents, including etanercept (n=8), adalimumab (n=8), infliximab (n=2), tocilizumab (n=2), abatacept (n=1), and golimumab (n=1) (median 1.5 patient-years). Four patients experienced marked increases in transaminase during treatment with adalimumab (n=2) and tocilizumab (n=2). Two patients (one using adalimumab, the other using tocilizumab) were treated with anti-viral agents and showed dramatic improvement in both the viral RNA and transaminase. One patient discontinued adalimumab due to the repeated elevated transaminase levels along with a twofold increase in the viral RNA titer, and the transaminase level subsequently normalized. No case of overt viral reactivation was identified.
CONCLUSION
The data support that changes in transaminase and/or viral load associated with biologic agents in HCV-infected RA patients are possible. Therefore, the liver function and viral RNA titer should be followed regularly during biologic therapy.

Keyword

Hepatitis C; Rheumatoid arthritis; Biological therapy; Antirheumatic agents

MeSH Terms

Abatacept
Adalimumab
Antirheumatic Agents
Arthritis, Rheumatoid*
Biological Factors
Biological Therapy*
Classification
Etanercept
Hepacivirus
Hepatitis C
Hepatitis C, Chronic*
Hepatitis, Chronic*
Hospitals, University
Humans
Infliximab
Korea
Liver
Retrospective Studies
Rheumatic Diseases
Rheumatology
RNA, Viral
Viral Load
Abatacept
Adalimumab
Antirheumatic Agents
Biological Factors
Etanercept
Infliximab
RNA, Viral

Figure

• 

  Figure 1. Conventional disease-modifying antirheumatic drug (DMARD) use in rheumatoid arthritis patients with chronic hepatitis C. HCQ: hydroxychloroquine, MTX: methotrexate, SSLZ: sulfasalazine, LEF: leflunomide, TAC: tacrolimus, CsA: cyclosporine A.

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