Spondyloarthropathy and chronic B hepatitis. Effect of anti-TNF therapy.
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.


METHODS
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.


CONCLUSIONS
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.
Wendling
Daniel
D
Service de Rhumatologie, CHU Minjoz, 25030 Besançon, France. dwendling@chu-besancon.fr
Di Martino
Vincent
V
Prati
Clément
C
Toussirot
Eric
E
Herbein
Georges
G
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects; D000069285:Infliximab; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D063065:Organophosphonates / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor; D025242:Spondylarthropathies / Q000188:drug therapy / Q000821:virology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000998:Antiviral Agents; D007074:Immunoglobulin G; D063065:Organophosphonates; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D019259:Lamivudine; C053001:adefovir; D000069285:Infliximab; D000225:Adenine; D000068800:Etanercept; D008727:Methotrexate