Effect of tumour necrosis factor alpha antagonists on serum transaminases and viraemia in patients with rheumatoid arthritis and chronic hepatitis C infection

Background: Tumour necrosis factor alpha (TNFalpha) antagonists are effective for the treatment of rheumatoid arthritis (RA), but concerns remain about the safety of these agents in the presence of chronic infections, including hepatitis C virus (HCV) infection. Objective: To examine the influence of treatment with TNFalpha antagonists on levels of HCV viraemia and serum transaminases in patients with RA and HCV. Methods: In a retrospective survey the course of 16 HCV infected patients with RA who had received the TNFalpha antagonists etanercept or infliximab was analysed. Eight additional patients with RA and HCV were also enrolled into a three month prospective trial of etanercept. Serum concentrations of albumin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and HCV were followed. Results: Viraemia was measured in 22 patients receiving a TNFalpha antagonist at the start of treatment and after 1-34 months (median 9 months follow up). Twenty four patients had serial tests of liver related enzymes and albumin. None of the differences between liver related tests at baseline and at follow up achieved significance (p > 0.05). Similarly, the mean HCV measurement at 1-3, 4-6, 7-12, and 13-34 months did not differ significantly from baseline (p > 0.05). Conclusion: In this study, liver related blood tests and HCV viral load measurements did not change substantially. These findings suggest that TNFalpha antagonists merit further study for the treatment of RA in HCV infected patients. Larger and longer term studies are still needed.