1. Spondyloarthropathy and chronic B hepatitis. Effect of anti-TNF therapy.
- Author
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Wendling D, Di Martino V, Prati C, Toussirot E, and Herbein G
- Subjects
- Adenine analogs & derivatives, Adenine therapeutic use, Adult, Antiviral Agents therapeutic use, Drug Therapy, Combination, Etanercept, Female, Hepatitis B virus drug effects, Hepatitis B virus immunology, Hepatitis B, Chronic drug therapy, Humans, Immunocompromised Host, Immunoglobulin G adverse effects, Infliximab, Lamivudine therapeutic use, Male, Methotrexate adverse effects, Organophosphonates therapeutic use, Receptors, Tumor Necrosis Factor, Spondylarthropathies drug therapy, Treatment Outcome, Viral Load, Virus Activation drug effects, Antibodies, Monoclonal adverse effects, Antirheumatic Agents adverse effects, Hepatitis B, Chronic complications, Spondylarthropathies virology, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Unlabelled: Several cases of TNF antagonist-related reactivation of hepatitis B have been reported. Here, we describe 4 cases in patients with spondyloarthropathies. Long-term monitoring of the hepatitis B virus (HBV) load is in order in HBV-positive patients treated with TNF antagonists., Case Reports: There were 3 men and 1 woman, aged 30-40 years. Follow-up ranged from 1 to 5 years. In 2 patients, the HBV infection was not discovered until the pre-TNF antagonist therapy workup. A viral load increase was noted after a TNF antagonist was added to methotrexate in 2 patients, whose viral load values returned to baseline after the introduction of the antiviral agent lamivudine. Lamivudine was started at the same time as the TNF antagonist in the other 2 patients, whose viral loads remained undetectable. Escape phenomenon requiring a switch to another antiviral agent was required in 1 patient after more than 4 years of treatment with 3 TNF antagonists., Conclusion: These 4 case reports illustrate the challenges raised by latent HBV infection in patients who require TNF antagonist therapy. They support routine HBV testing before treatment initiation, followed in HBV-positive patients by viral load monitoring. Antiviral therapy can be used preventively and should be given if the viral load increases under TNF antagonist therapy. In patients on antiviral therapy, viral load monitoring should be continued, given the risk of escape phenomenon after several years.
- Published
- 2009
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