Short-term course of chronic hepatitis B and C under treatment with etanercept associated with different disease modifying antirheumatic drugs without antiviral prophylaxis.

OBJECTIVE: To evaluate the short-term course of chronic hepatitis B and C under treatment with etanercept (ETN) associated with different disease modifying antirheumatic drugs (DMARD).
METHODS: Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) receiving anti-tumor necrosis factor-a (TNF-a) were retrospectively reviewed for the presence of hepatitis B or C serology, liver function tests, liver biopsy findings, and the relevant outcomes in terms of viral load.
RESULTS: We identified 5 relevant cases receiving ETN, 3 RA patients with chronic hepatitis C, another RA patient with dual infection by B and C, and one AS patient with hepatitis B. Four patients met the American College of Rheumatology criteria for RA. The patient with AS fulfilled the modified New York diagnostic criteria for AS. In Case 1, ETN was started after having discontinued a-interferon and ribavirin due to viral clearance of hepatitis C. These patients had not received prophylactic antiviral therapy while being treated with ETN. Viral replication increased in 2 patients to an insignificant level, remained negative in 2, and decreased in the remaining one. No significant rise in patients' liver transaminases could be determined during followup.
CONCLUSION: We observed reactivation of hepatitis C virus infection in 2 of 4 patients while they were receiving ETN with DMARD without antiviral prophylaxis.