Safety of anti-tumour necrosis factor agents in patients with chronic hepatitis C infection: a systematic review

Objectives. To identify all of the patients affected by chronic hepatitis C infection treated with TNF-alpha blockers (adalimumab, certolizumab pegol, etanercept, golimumab and infliximab) in order to evaluate the safety profile. Methods. A systematic review of the literature from January 1990 to October 2010. Results. In total, 37 publications with data on 153 patients who were treated with anti-TNF-alpha agents in the setting of HCV infection were found. The mean anti-TNF-alpha treatment duration was 11.9 months. Ninety-one patients had RA, 22 had psoriasis, 6 had Crohn's disease and 14 patients had other chronic inflammatory diseases. To date, etanercept is the biological agent that has been most extensively used in the patients with HCV infection, with only one definitely confirmed case of HCV hepatitis worsening and five suspected cases (elevation of transaminases not associated with an increase in the HCV viral load and vice versa) in 110 treated patients. Treatment with this agent resulted in stable levels of liver transaminases and a stable viral load in 74 patients, with an improvement in HCV chronic liver disease in combination with IFN-ribavirin therapy in 29 patients. Conclusions. The safety profile of anti-TNF-alpha agents in the setting of HCV infection seems to be acceptable, even if differences in the hepatotoxic profile are apparent between different agents. In the absence of long-term and large, controlled clinical trials a definitive statement on the safety of anti-TNF-alpha therapies in the setting of chronic HCV infection cannot be made.