Subfulminant hepatitis B during treatment with adalimumab in a patient with rheumatoid arthritis and chronic hepatitis B

Eur J Gastroenterol Hepatol. 2010 Apr;22(4):494-9. doi: 10.1097/meg.0b013e3283329d13.

Abstract

We report a case of reactivation of hepatitis B virus (HBV) infection with subacute liver failure during administration of adalimumab, followed by a literature review of all 19 published cases, with a focus on the effect of antiviral prophylaxis. Eight patients were given prophylaxis and had a good outcome. Of the 11 patients without prophylaxis, six patients developed a reactivation and needed to stop anti-TNFalpha therapy (P = 0.017). One patient developed an acute liver failure, necessitating urgent liver transplantation. One patient died. Administration of anti-TNFalpha therapy can lead to HBV reactivation, with a possible lethal outcome. High-risk patients and possibly all patients should be screened for hepatitis B surface antigen and anti-HBV core antibody before starting anti-TNFalpha therapy. Administration of antiviral prophylaxis proves beneficial in prevention of reactivation in hepatitis B surface antigen positive patients.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adalimumab
  • Anti-Inflammatory Agents / adverse effects*
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Humanized
  • Arthritis, Rheumatoid / drug therapy
  • Hepatitis B virus / physiology*
  • Hepatitis B, Chronic / virology*
  • Humans
  • Liver Function Tests
  • Male
  • Middle Aged
  • Recurrence
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Virus Activation

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Tumor Necrosis Factor-alpha
  • Adalimumab