Treatment of Inflammatory Bowel Disease with Anti-TNF Agents in Patients with Chronic Hepatitis C Virus (HCV) Infection - A Systematic Review of Literature

Abstract

Purpose: Anti-tumor necrosis factor (TNF) therapy has been shown to be highly efficacious in the treatment of inflammatory bowel disease (IBD). However, there is a concern that inhibition of TNF may have immunosuppressive effects leading to HCV replication and worsening of liver disease. The aim of this study was to perform a systematic review of the literature regarding the treatment of IBD with anti-TNF agents in patients with chronic HCV infection. Methods: A systematic search of the literature was performed. Databases of literature examined included MEDLINE, EMBASE and PUBMED using key words: hepatitis C, ulcerative colitis, Crohn's disease, inflammatory bowel disease, anti-TNF, infliximab, certolizumab and adalimumab. Articles searched were from 1910 to May 2010. Only full-length, English-written original studies and case-reports that described the effects of anti-TNF treatment on the course of IBD and the liver function in patients with IBD and concomitant chronic HCV infection were included in the analysis.Table: [1233]Results: The search yielded a total of 1312 articles, of which 10 were included in full review and only 3 met inclusion criteria. These 3 studies were case reports, describing a total of 4 cases of treatment with anti-TNF agent, infliximab, in patients with IBD (namely Crohn's disease [CD]) and concomitant chronic HCV infection. The excluded 7 articles were either review articles, original articles not evaluating anti-TNF treatment in patients with IBD or case report describing the disseminated aspergillosis in patient with chronic HCV infection and CD who was treated with infliximab but not providing any details on the course of CD or the hepatic biochemical tests. The findings of these studies are presented in the Table. There were no original studies identified that assessed the treatment of IBD with anti-TNF agent in patients with chronic HCV infection. Conclusion: There are limited data on the use of anti-TNF agents in patients with IBD and chronic HCV infection. The results of our systematic review indicate that therapy with anti-TNF agents does not exacerbate the course of chronic HCV infection. Further, in the limited data available, interferon based therapy has been successfully used to clear HCV infection, while not inducing a flare of liver disease. Large scale studies are needed to fully evaluate the effects of anti-TNF treatment on the course of chronic HCV infection in patients who have a background of IBD. The course of IBD while on interferon based therapy also needs to be assessed in larger studies. Disclosure: Gary R. Lichtenstein, Md Potential Conflict of Interest Declaration Abbott Corporation Consultant Alaven Consultant Bristol-Myers Squibb Research Centocor Orthobiotech Consultant, Research Elan Consultant Ferring Consultant, Research Millenium Pharmaceuticals Consultant Proctor and Gamble Consultant, Research Prometheus Laboratories, Inc. Consultant, Research Salix Pharmaceuticals Consultant, Research Schering-Plough Corporation Consultant Shire Pharmaceuticals Consultant, Research UCB Consultant, Research Warner Chilcotte Consultant, Research Wyeth Consultant.