Abstract
Background: In the last years, inflammatory bowel disease (IBD) and hepatitis C virus (HCV) infection management has completely changed. However, the role of direct-acting antivirals (DAAs) and the correct timing of antiviral drugs administration in IBD patients needing biologics has not been evaluated.Objective: To discuss the management of HCV-infected IBD patients, focusing our attention on the timing of DAAs administration subjects needing biologics.Methods: Relevant articles addressing HCV management in patients needing biologics were identified by searching from PubMed, MEDLINE and Scopus.Results: Three possible timing strategies were identified: (1) sequential strategy, meaning the choice of treating firstly the active IBD with biologics and then, once the acute phase has been controlled, treating the HCV infection; (2) concomitant strategy, that is the contemporaneous beginning of DAAs and biologics administration; (3) inverted sequential strategy—the administration of antiviral therapy before biologics in HCV-infected IBD patients. The potential pharmacological interactions between biologics and DAAs have also been reported.Conclusions: Clinical management of HCV-infected IBD patients remains a challenging problem for clinicians, especially in terms of timing choice. Recent published data about DAAs are very encouraging also in IBD patients. All strategies could be considered safe and effective. However, further data are immediately required in order to evaluate hepatic toxicity of novel immunosuppressive drugs in IBD.
Highlights
Inflammatory Bowel Diseases (IBD) and hepatitis C virus (HCV) infection are common conditions throughout the world, with an estimated prevalence of HCV infection in IBD subjects ranging from 1 to 6% in Western countries (Biancone et al, 2001; Loras et al, 2009; Chevaux et al, 2010)
Infliximab, adalimumab, and golimumab have been approved for use in induction and maintenance of remission in ulcerative colitis (UC), while only infliximab and adalimumab have been approved in Crohn’s disease (CD)
Another biologic drug has been approved for induction and maintenance of both CD and UC: vedolizumab
Summary
Inflammatory Bowel Diseases (IBD) and hepatitis C virus (HCV) infection are common conditions throughout the world, with an estimated prevalence of HCV infection in IBD subjects ranging from 1 to 6% in Western countries (Biancone et al, 2001; Loras et al, 2009; Chevaux et al, 2010). DAAs and Biologics in HCV-Infected IBD Subjects of drugs [immunosuppressant (azathioprine, methotrexate) and biological therapies (infliximab, adalimumab, golimumab, vedolizumab) for IBD and direct-acting antivirals (DAAs) for HCV], with a great impact on the clinical course of these diseases (Scherzer et al, 2008; Gisbert et al, 2011; Allen et al, 2013; Caso et al, 2015; Safroneeva et al, 2015) Since their introduction, anti-TNF agents have become widely used in moderate-to-severe IBD. Different mechanisms of action potentially contribute to the effectiveness of biologics, including neutralization of circulating TNF, inhibition of TNF binding to its receptor, and reverse signaling (Ben-Horin et al, 2016) Another biologic drug has been approved for induction and maintenance of both CD and UC: vedolizumab. The role of direct-acting antivirals (DAAs) and the correct timing of antiviral drugs administration in IBD patients needing biologics has not been evaluated
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