J Rheum Dis 2018; 25(2): 108-115  
Transaminase Changes in Korean Rheumatoid Arthritis Patients with Chronic Hepatitis C after Biologic Therapy
Hyun Mi Kwon1, Kichul Shin2, Jin Young Moon1, Shin-Seok Lee3, Won Tae Chung4, Jisoo Lee5, Sang-Heon Lee6, Seong-Wook Kang7, Chang Hee Suh8, Seung-Jae Hong9, Ran Song10, Jung-Yoon Choe11, Yeong Wook Song1,12
Division of Rheumatology, Department of Internal Medicine, 1Seoul National University Hospital, 2SMG-SNU Boramae Medical Center, Seoul, 3Chonnam National University Hospital, Gwangju, 4Dong-A University Hospital, Busan, 5Ewha Womans University Mokdong Hospital, 6Konkuk University Medical Center, Seoul, 7Chungnam National University Hospital, Daejeon, 8Ajou University Hospital, Suwon, 9Kyung Hee University Medical Center, 10Kyung Hee University Hospital at Gangdong, Seoul, 11Daegu Catholic University Medical Center, Daegu, 12Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
Correspondence to: Yeong Wook Song http://orcid.org/0000-0002-5384-3437
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail:ysong@snu.ac.kr
Received: October 11, 2017; Revised: December 8, 2017; Accepted: December 29, 2017; Published online: April 1, 2018.
© Korean College of Rheumatology. All rights reserved.

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Abstract
Objective. Coexisting chronic hepatitis C can be problematic when treating rheumatoid arthritis (RA). This study examined the changes in the transaminase and viral load in hepatitis C virus (HCV)-infected RA patients after initiating biologic agents. Methods. A multicenter retrospective study was conducted at 12 University Hospitals in Korea between November 2014 and November 2015, and 78 RA patients, who met the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA and were concomitantly infected with HCV, were identified. The baseline and longitudinal clinical data, changes in liver function, and viral RNA titers were evaluated. Results. Seventeen (21.8%) patients were treated with biologic agents, including etanercept (n=8), adalimumab (n=8), infliximab (n=2), tocilizumab (n=2), abatacept (n=1), and golimumab (n=1) (median 1.5 patient-years). Four patients experienced marked increases in transaminase during treatment with adalimumab (n=2) and tocilizumab (n=2). Two patients (one using adalimumab, the other using tocilizumab) were treated with anti-viral agents and showed dramatic improvement in both the viral RNA and transaminase. One patient discontinued adalimumab due to the repeated elevated transaminase levels along with a twofold increase in the viral RNA titer, and the transaminase level subsequently normalized. No case of overt viral reactivation was identified. Conclusion. The data support that changes in transaminase and/or viral load associated with biologic agents in HCV-infected RA patients are possible. Therefore, the liver function and viral RNA titer should be followed regularly during biologic therapy.
Keywords: Hepatitis C, Rheumatoid arthritis, Biological therapy, Antirheumatic agents


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