School of Pharmacy, University of Wyoming, Cheyenne, WY, USA.
Ann Pharmacother. 2011 Apr;45(4):e23. doi: 10.1345/aph.1P504. Epub 2011 Apr 5.
To describe a case of gold sodium thiomalate use for the treatment of rheumatoid arthritis (RA) in a patient with hepatitis B.
A 53-year-old Korean American woman with mild RA and chronic hepatitis B infection was treated for worsening RA symptoms with subcutaneous injections of gold sodium thiomalate for 21 months, with the dosage decreased from the initial 40 mg per week to 40 mg every 3 weeks after 51 weeks of successful treatment. She had undergone treatment for hepatitis B in the past with lamivudine; however, she had not received that medication for at least 1 year prior to initiating treatment with gold sodium thiomalate injections. During the treatment period she achieved remission of RA without a significant elevation of her liver enzyme levels or reactivation of hepatitis B.
Two main factors influence drug product selection when considering the subset of RA patients with chronic hepatitis B infection: severity of liver function compromise and treatment status of chronic hepatitis B. Our patient did not demonstrate significant liver function compromise, but was not receiving viral suppressive treatment for hepatitis B; therefore, the use of many first-line nonbiologic disease-modifying antirheumatic drugs (DMARDs) was contra-indicated based on current guideline recommendations. Additionally, because the patient had refused viral suppressive therapy, there was great concern with the use of biological DMARDs and potential reactivation of hepatitis B. In the past, gold salts were the standard of care in treating RA until the development of the newer agents and there was some evidence that gold sodium thiomalate could be used with minimal risk of hepatotoxicity.
Gold sodium thiomalate proved to be a safe and effective treatment option in a patient with RA and hepatitis B.
描述 1 例乙型肝炎患者使用硫代苹果酸金钠治疗类风湿关节炎（RA）的病例。
1 名 53 岁的韩裔美国女性患有轻度 RA 和慢性乙型肝炎感染，在过去曾接受过拉米夫定治疗乙型肝炎，在过去 1 年未接受该药治疗后，开始接受硫代苹果酸金钠皮下注射治疗，治疗 21 个月，初始剂量为每周 40mg，治疗 51 周后成功将剂量减少至每 3 周 40mg。她因 RA 症状加重而接受治疗，在治疗期间，她实现了 RA 的缓解，而肝酶水平没有明显升高，也没有乙型肝炎再激活。
当考虑慢性乙型肝炎感染的 RA 患者亚组时，有两个主要因素影响药物产品的选择：肝功能损害的严重程度和慢性乙型肝炎的治疗状况。我们的患者没有表现出明显的肝功能损害，但没有接受乙型肝炎的病毒抑制治疗；因此，根据当前指南建议，许多一线非生物性疾病修饰抗风湿药物（DMARDs）的使用是禁忌的。此外，由于患者拒绝接受病毒抑制治疗，因此非常担心使用生物 DMARDs 和乙型肝炎的潜在再激活。过去，金盐是治疗 RA 的标准治疗方法，直到新型药物的开发，并且有一些证据表明硫代苹果酸金钠的使用具有最小的肝毒性风险。
硫代苹果酸金钠被证明是治疗 RA 和乙型肝炎患者的安全有效的治疗选择。
