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Long-term safety of anti-TNF treatment in patients with rheumatic diseases and chronic or resolved hepatitis B virus infection
  1. D Vassilopoulos,
  2. A Apostolopoulou,
  3. E Hadziyannis,
  4. G V Papatheodoridis,
  5. S Manolakopoulos,
  6. J Koskinas,
  7. E K Manesis,
  8. A I Archimandritis
  1. 2nd Department of Medicine, Hippokration General Hospital, Athens University School of Medicine, Athens, Greece
  1. Correspondence to Dr Dimitrios Vassilopoulos, Assistant Professor of Medicine-Rheumatology, 2nd Department of Medicine, Hippokration General Hospital, Athens University School of Medicine, 114 Vass. Sophias Avenue, Athens 115 27, Greece; dvassilop{at}


Objectives The aim of this prospective study was to examine the safety of anti-tumour necrosis factor (TNF) therapy in patients with rheumatic disease and hepatitis B virus (HBV) infection.

Methods 14 patients with chronic HBV infection, 19 HBV-vaccinated patients and 19 patients with resolved HBV infection were included in the study. All HBV-infected patients received combination therapy with oral antivirals and anti-TNF agents. During treatment the levels of hepatitis B surface antibodies (anti-HBs) in HBV-vaccinated patients and of serum HBV DNA in patients with chronic or resolved HBV infection were monitored.

Results No viral reactivation was observed in patients with resolved HBV infection while anti-HBs titres decreased during anti-TNF treatment in vaccinated patients, similarly to patients treated with methotrexate alone. None of the HBV-infected patients developed liver decompensation or a significant increase in alanine aminotransferase levels. One patient (7%) treated with lamivudine and etanercept showed viral reactivation due to the emergence of a lamivudine-resistant mutant strain.

Conclusions Anti-TNF agents represent a safe option for patients with chronic HBV infection when combined with antiviral therapy, as well as in patients previously exposed to HBV receiving no HBV prophylaxis. Resistant HBV strains may arise in patients with chronic hepatitis B, necessitating the initial use of anti-HBV agents with a low risk of resistance.

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  • Funding This work was supported in part by a research grant from the Hellenic Society for Rheumatology.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the institutional review board of the Hippokration General Hospital, Athens, Greece and all patients signed an informed consent prior to their enrolment in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.