Abstract
Biologic agents have increased the therapeutic armamentarium against immune-mediated disorders, and particularly rheumatic diseases such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Nevertheless, infectious side effects are a major concern in the use of these biologics, especially anti-tumor necrosis factor (TNF) agents1. In this context, the use of TNF blockers in patients with chronic viral infection seems hazardous, and represents an unresolved issue2. In this issue of The Journal , Zingarelli, et al 3 report 3 cases of patients with RA positive for HBsAg, in which anti-TNF therapies (etanercept, infliximab then etanercept, adalimumab) under prophylactic use of lamivudine were not associated with hepatitis reactivation, even after anti-TNF discontinuation with prolonged lamivudine therapy. In one of their cases, an increase in HBV viral load occurred after discontinuation of methotrexate. Methotrexate was reported to induce subfulminant hepatitis B virus reactivation after its withdrawal4,5. This illustrates the interactions of the underlying condition and the associated immunosuppressive therapy that may confuse our interpretation of the responsibility of … Address reprint requests to Dr. Wendling. E-mail: dwendling{at}chu-besancon.fr
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