Department of Environmental Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
Rheumatology (Oxford). 2011 Sep;50(9):1700-11. doi: 10.1093/rheumatology/ker190. Epub 2011 Jun 20.
To identify all of the patients affected by chronic hepatitis C infection treated with TNF-α blockers (adalimumab, certolizumab pegol, etanercept, golimumab and infliximab) in order to evaluate the safety profile.
A systematic review of the literature from January 1990 to October 2010.
In total, 37 publications with data on 153 patients who were treated with anti-TNF-α agents in the setting of HCV infection were found. The mean anti-TNF-α treatment duration was 11.9 months. Ninety-one patients had RA, 22 had psoriasis, 6 had Crohn's disease and 14 patients had other chronic inflammatory diseases. To date, etanercept is the biological agent that has been most extensively used in the patients with HCV infection, with only one definitely confirmed case of HCV hepatitis worsening and five suspected cases (elevation of transaminases not associated with an increase in the HCV viral load and vice versa) in 110 treated patients. Treatment with this agent resulted in stable levels of liver transaminases and a stable viral load in 74 patients, with an improvement in HCV chronic liver disease in combination with IFN-ribavirin therapy in 29 patients.
The safety profile of anti-TNF-α agents in the setting of HCV infection seems to be acceptable, even if differences in the hepatotoxic profile are apparent between different agents. In the absence of long-term and large, controlled clinical trials a definitive statement on the safety of anti-TNF-α therapies in the setting of chronic HCV infection cannot be made.
确定所有接受 TNF-α 阻滞剂（阿达木单抗、培塞利珠单抗、依那西普、戈利木单抗和英夫利昔单抗）治疗的慢性丙型肝炎感染患者，以评估安全性概况。
对 1990 年 1 月至 2010 年 10 月的文献进行系统回顾。
共发现 37 篇文献，其中有 153 例患者在 HCV 感染背景下接受了抗 TNF-α 药物治疗的数据。抗 TNF-α 治疗的平均持续时间为 11.9 个月。91 例患者患有 RA，22 例患有银屑病，6 例患有克罗恩病，14 例患者患有其他慢性炎症性疾病。迄今为止，依那西普是在 HCV 感染患者中使用最广泛的生物制剂，在 110 例接受治疗的患者中，仅确认了 1 例 HCV 肝炎恶化和 5 例疑似病例（转氨酶升高与 HCV 病毒载量增加无关，反之亦然）。该药物治疗使 74 例患者的肝转氨酶水平稳定，病毒载量稳定，29 例患者联合 IFN-利巴韦林治疗改善了 HCV 慢性肝病。
在 HCV 感染背景下使用抗 TNF-α 药物的安全性概况似乎是可以接受的，即使不同药物之间的肝毒性特征存在差异。在缺乏长期、大规模的对照临床试验的情况下，不能对慢性 HCV 感染背景下抗 TNF-α 治疗的安全性做出明确的结论。
