Effect of etanercept and entecavil in a patient with rheumatoid arthritis who is a hepatitis B carrier: a review of the literature

Abstract

In this report, we describe a case of a 48-year-old Japanese woman who is a hepatitis B (HB) carrier with rheumatoid arthritis (RA). She had the following antibody profile: HBs Ag(+), HBs Ab(-), HBe Ag(-), HBe Ab (+), HBc Ab(-) and undetectable HBV-DNA level. She was treated with auranofin, salazosulfapyridine, and bucillamine. Finally, she was treated with D: -penicillamine, but her disease activity remained elevated. Prophylactic treatment of entecavir 0.5 mg daily was started in March 2008 and all disease-modifying anti-rheumatic drugs were stopped. After 2 weeks, etanercept monotherapy was started at 25 mg subcutaneously once a week. Significant improvement in clinical parameters of disease activity and well being was observed. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and HB virus viral load did not change significantly. Serum ALT, AST, and HB virus viral load were followed-up at every 3-month intervals, from initiation of therapy up to 24 months after the start of treatment with etanercept. We have also summarized the course of nine RA patients who received etanercept and were HB carriers or had chronic HB according to our literature search. Based on the results of our study, treatment of these patients with etanercept co-administered with lamivudine or entecavir appears to be safe.

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2012: Table 1

“…Although specific warnings about hepatitis B reactivation have been added to the US label by the FDA, TNFi have been used in patients with known persistent hepatitis B infection, with concomitant hepatitis B treatment (category B evidence518). If hepatitis B infection is discovered during use of TNFi, prophylactic antiviral treatment can be employed (category C evidence516).…”

Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts

“…In particular, rituximab, an anti-CD20 monoclonal antibody used for combined chemotherapy of malignant lymphoma, frequently induces HBV reactivation not only in HBsAg-positive patients, but also in HBsAg-negative patients [6][7][8]. Several studies have reported that infliximab, a monoclonal antibody against tumor necrosis factor-a (anti-TNF-a), induced HBV reactivation in HBsAg-positive patients with Crohn's disease or rheumatoid arthritis (RA) [9][10][11]. Recent case reports showed that HBV reactivation occurred in HBV carriers with RA who received etanercept, adalimumab, or rituximab [12,13].…”

Entecavir and Intermittent Etanercept Therapy in a Patient with Concurrent Hepatitis B Virus Infection and Psoriasis

“…In these particular cases, a multidisciplinary collaboration with a hepatologist is mandatory for the definition of a therapeutic or prophylactic regimen with an antiviral treatment (lamivudine, adefovir, tenofovir, telbivudine, entecavir), as shown by several reports in the literature (2,6,7,10). In our case, due to the severity of psoriasis and the particular psychological patient profile, the risk/benefit ratio led to the decision to start an anti-TNF-a treatment.…”

“…Among anti-TNF-a agents etanercept was preferred due to its efficacy and safety profile bound to its biochemical and pharmacological characteristics (soluble TNF-a receptor fusion protein) and for the option to use the drug with intermittent regimens (1,(6)(7)(8)(9). Etanercept was administered in combination with entecavir, an oral deoxyguanosine nucleoside analogue with potent activity against HBV and a high genetic barrier to resistance (10,11), recommended as first-line monotherapy and indicated for long-term use in chronic hepatitis B. Entecavir is administered orally at a dosage of 0.5 or 1 mg/day for a variable period of time depending primarily on HBe or HBs seroconversion. Follow-up visits are usually performed every 3-6 months (10, 11).…”