Safety of Etanercept and Methotrexate in Patients with Rheumatoid Arthritis and Hepatitis C Virus Infection: A Multicenter Randomized Clinical Trial

Objective. To evaluate the safety and efficacy of therapy with etanercept and methotrexate (MTX) in patients with active rheumatoid arthritis (RA) and mild hepatitis C virus (HCV) infection. Methods. In this prospective open study, 29 patients with active RA were randomly assigned to receive therapy with MTX alone, etanercept alone, or a combination of MTX and etanercept, and monitored up to 54 weeks. The primary endpoint was safety; secondary aims were efficacy as defined by the 44-joint Disease Activity Score (DAS44) and health assessment questionnaire (HAQ). Serum liver enzymes and HCV viral load were serially measured. Results. In the whole cohort, aspartate aminotransferase (AST) serum levels were (mean SD) 35 +/- 3 at entry, 39 +/- 5,41 7, and 38 +/- 4 at 14, 30, and 54 weeks, respectively; alanine aminotransferase (ALT) serum levels were 43 +/- 5 at entry, 47 +/- 5, 53 +/- 9, and 50 +/- 6 at 14, 30, and 54 weeks, respectively. HCV viral load was 5.6 +/- 0.5 at entry, 5.9 +/- 0.6, 5.7 +/- 0.3, and 5.6 +/- 0.6 at 14, 30, and 54 weeks, respectively. AST and ALT did not significantly change in all 3 arms of treatment, nor did HCV viral load. A significant reduction of DAS44 (p <0.01) and HAQ (p <0.04) was detected at 54 weeks compared to baseline. No patient discontinued the therapy because of worsening of liver disease. Conclusion. This study showed that patients with RA and chronic HCV and mild hepatitis may be successfully treated with etanercept and MTX without increasing the risk of hepatotoxicity and HCV replication.