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A comparison of safety profiles of tumour necrosis factor α inhibitors and rituximab therapy in patients with rheumatoid arthritis and chronic hepatitis C
  1. Yi-Ming Chen1,2,3,4,
  2. Hsin-Hua Chen1,2,
  3. Yi-Hsing Chen1,2,
  4. Tsu-Yi Hsieh1,
  5. Chia-Wei Hsieh1,3,4,
  6. Wei-Ting Hung1,
  7. Joung-Liang Lan5,6,
  8. Der-Yuan Chen1,2,3,4,7
  1. 1Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
  3. 3Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
  4. 4Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
  5. 5Division of Immunology and Rheumatology, China Medical University Hospital, Taichung, Taiwan
  6. 6College of Medicine, China Medical University, Taichung, Taiwan
  7. 7Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
  1. Correspondence to Dr Der-Yuan Chen, Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan; No. 1650, Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan; dychen{at}vghtc.gov.tw

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Hepatitis C virus (HCV) infection is prevalent worldwide and is associated with cirrhosis and hepatocellular carcinoma. Although antitumour necrosis factor (anti-TNF) α agents may affect the competence of the immune system against viral infection,1 some studies have demonstrated that TNF-α inhibitors may be safe in patients with chronic HCV infection.2 ,3 A recent randomised clinical trial showed that rheumatoid arthritis (RA) patients with chronic HCV were treated successfully with etanercept without elevation of transaminases and HCV viral load.4 However, rituximab (RTX) is associated with increasing HCV RNA levels in lymphoma patients undergoing RTX combined with chemotherapy.5 ,6 RTX-related HCV reactivation was also observed in RA patients.7 Therefore, biological therapies of different mechanism of action may influence on HCV replication differently. To test this hypothesis, we conducted a retrospective safety profile review of RA patients with concomitant HCV infection treated …

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