Table 5.
Hepatotoxicity and reactivation of hepatitis C in patients treated with DMARDs or immunosuppressants
| Author-year/country | Patients (N) | Concurrent antivirals* (%) | Disease | Treatment | Increase in LFTs N (%) |
Increase in viral load N (%) |
RoB |
| Iannone et al164 2014/Italy† | 29 | 0% | RA | Etanercept or MTX or combination | 0 (0) | 0 (0) | Some concerns |
| Burton et al165 2017/USA | 748‡ | 4.6% | RA | DMARDs | 37 (3.4) | 0 (0) | 7 |
| Chen et al166 2015/Taiwan | 26§ | NS | SLE | Immunosuppressants | 10 (38.5)¶ | 10 (38.5)¶ | 6 |
| Costa et al160 2014/Italy | 15 | NS | PsA | TNFi | 0 (0) | 0 (0) | 6 |
| Parke et al161 2004/USA | 5 | 0% | RA | TNFi | 0 (0) | 1 (20)** | 6 |
| Peterson et al162 2003/USA | 24 | 0% | RA | Etanercept or Infliximab | 0 (0) | 6/22 (27.3)†† | 6 |
| Gandhi et al163 2017/USA | 14‡‡ | 14.3% | RA, PsA | Etanercept | 7 (50.0) | 5/10 (50.0) | 5 |
*Patients concurrently treated with antivirals.
†Randomised controled trial.
‡1097 treatment-episodes.
§Anti-HCV+, baseline RNA not stated.
¶Increase in viral load or LFTs.
**Was not combined with liver injury.
††No significant differences were seen between the mean viral loads at baseline and follow-up.
‡‡5/7 were RNA-positive.
DMARDs, disease modifying anti-rheumatic drug; HCV, hepatitis C virus; IMID, immune-mediated diseases; LFTs, liver function tests; MTX, methotrexate; NS, not significant; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RoB, risk of bias.