Assessing risk of liver enzyme elevation in patients with immune-mediated diseases and different hepatitis B virus serostatus receiving anti-TNF agents: a nested case-control study

被引:4
作者
Chiu, Ying-Ming [1 ,2 ]
Lai, Mei-Shu [3 ]
Chan, K. Arnold [3 ,4 ,5 ]
机构
[1] Changhua Christian Hosp, Div Allergy Immunol & Rheumatol, 135 Nanxiao St, Changhua 50006, Taiwan
[2] Hungkuang Univ, Dept Nursing, Coll Med & Nursing, Taichung, Taiwan
[3] Natl Taiwan Univ, Grad Inst Epidemiol & Prevent Med, Coll Publ Hlth, Taipei, Taiwan
[4] Natl Taiwan Univ Hosp, Dept Med Res, Taipei, Taiwan
[5] Natl Taiwan Univ, Grad Inst Oncol, Coll Med, Taipei, Taiwan
关键词
Hepatitis B virus; HBsAg(+); HBsAg(-)/HBcAb(+); Liver enzyme elevation; Anti-TNF; OF-THE-LITERATURE; RHEUMATOID-ARTHRITIS; IMMUNOSUPPRESSIVE THERAPY; AUTOIMMUNE-DISEASES; ANTIRHEUMATIC DRUGS; ALPHA AGENTS; FATTY LIVER; C VIRUS; REACTIVATION; INFECTION;
D O I
10.1186/s13075-017-1413-y
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Liver enzyme elevation is an important and common adverse effect among patients with immune-mediated diseases who receive tumour necrosis factor inhibitors (anti-TNF), and has various causes. Hence, we evaluated the relative risks of developing liver enzyme elevation in anti-TNF users with differing hepatitis B virus (HBV) infection status. Methods: At a hospital in central Taiwan, 407 patients with rheumatoid arthritis, ankylosing spondylitis, or psoriasis/psoriatic arthritis received anti-TNF therapy between 1 January 2004 and 30 June 2012. We performed a nested case-control study (n = 368) of cases with serum alanine aminotransferase (ALT) > 40 international units/L <= 12 months after starting anti-TNF therapy, and corresponding controls without liver enzyme elevation. Conditional logistic regression was used to evaluate associations between liver enzyme elevation and HBV serostatus, as well as other risk factors. Results: Thirty cases were compared to 338 controls. After adjustment for potential confounders, HBV surface antigen-positive (HBsAg(+)) serostatus was associated with substantially higher likelihood of developing elevated ALT (adjusted odds ratio 7.91, 95% confidence interval (CI) 2.16-31.31) relative to those with an uninfected HBV status; no such association was observed among HBsAg-negative/HBV core antibody-positive (HBsAg(-)/HBcAb(+)) patients (adjusted odds ratio 1.00, 95% CI 0.33-3.25). Increased risk of ALT elevation was associated with methotrexate used alone, without folic acid (adjusted odds ratio 11.60, 95% CI 2.52-56.46), and history of ALT elevation (adjusted odds ratio 13.71, 95% CI 4.32-45.75). Conclusions: HBsAg(+) patients with immune-mediated diseases who received anti-TNF therapy had an approximately eight-fold higher likelihood of liver enzyme elevation than those without HBV infection, whereas patients with HBsAg(-)/HBcAb(+) serostatus had a risk similar to that of uninfected patients.
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页数:9
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共 40 条
[1]   Hepatotoxicity related to antirheumatic drugs [J].
Aithal, Guruprasad P. .
NATURE REVIEWS RHEUMATOLOGY, 2011, 7 (03) :139-150
[2]  
Albrecht K, 2010, CLIN EXP RHEUMATOL, V28, pS95
[3]   Hepatotoxicity rates do not differ in patients with rheumatoid arthritis and psoriasis treated with methotrexate [J].
Amital, Howard ;
Arnson, Yoav ;
Chodick, Gabriel ;
Shalev, Varda .
RHEUMATOLOGY, 2009, 48 (09) :1107-1110
[4]   Nonalcoholic fatty liver disease and aging: Epidemiology to management [J].
Bertolotti, Marco ;
Lonardo, Amedeo ;
Mussi, Chiara ;
Baldelli, Enrica ;
Pellegrini, Elisa ;
Ballestri, Stefano ;
Romagnoli, Dante ;
Loria, Paola .
WORLD JOURNAL OF GASTROENTEROLOGY, 2014, 20 (39) :14185-14204
[5]   Safety of Tumor Necrosis Factor α Blockers in Hepatitis B Virus Occult Carriers (Hepatitis B Surface Antigen Negative/Anti-Hepatitis B Core Antigen Positive) With Rheumatic Diseases [J].
Caporali, R. ;
Bobbio-Pallavicini, F. ;
Atzeni, F. ;
Sakellariou, G. ;
Caprioli, M. ;
Montecucco, C. ;
Sarzi-Puttini, P. .
ARTHRITIS CARE & RESEARCH, 2010, 62 (06) :749-754
[6]   Use of tumor necrosis factor α inhibitors in hepatitis B surface antigen-positive patients: a literature review and potential mechanisms of action [J].
Carroll, Matthew B. ;
Forgione, Michael A. .
CLINICAL RHEUMATOLOGY, 2010, 29 (09) :1021-1029
[7]   Gender, fatty liver and GGT [J].
Carulli, L ;
Lonardo, A ;
Lombardini, S ;
Marchesini, G ;
Loria, P .
HEPATOLOGY, 2006, 44 (01) :278-279
[8]   Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants [J].
Chen, Chien-Hung ;
Yang, Pei-Ming ;
Huang, Guan-Tarn ;
Lee, Hsuan-Shu ;
Sung, Juei-Low ;
Sheu, Jin-Chuan .
JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION, 2007, 106 (02) :148-155
[9]  
Chen YH., 2012, FORMOS J RHEUMATOL, V26, P1
[10]   Use of anti-tumor necrosis factor-a therapy in hepatitis B virus carriers with psoriasis or psoriatic arthritis: A case series in Taiwan [J].
Cho, Yung-Tsu ;
Chen, Chien-Hung ;
Chiu, Hsien-Yi ;
Tsai, Tsen-Fang .
JOURNAL OF DERMATOLOGY, 2012, 39 (03) :269-273