Comparisons of Hepatitis C Viral Replication in Patients with Rheumatoid Arthritis Receiving Tocilizumab, Abatacept and Tofacitinib Therapy

Ann Rheum Dis. 2019 Jun;78(6):849-850.

Tocilizumab (TCZ), abatacept (ABA) and tofacitinib (TOF) appear to have no major safety concerns for treatment of RA patients with hepatitis C virus (HCV) infections.HCV is an infectious disease which continues to present a major therapeutic challenge for clinicians in treating patients with RA. Previous reports demonstrate that the use of TNF targeted therapies in RA patients with HCV infections appear to have no major safety concerns. During short-term therapy with TCZ and ABA, data has shown that viral load in HCV-infected RA patients appears to be unaffected. Currently, it remains unclear whether TOF affects HCV viral activity in these patients.Here, we report data from a prospective study, which aimed to assess the impact of non-TNF bDMARDs and JAK inhibitors on viral replication. Thirty-two RA patients with concomitant HCV infection were treated with either TCZ (n=8), ABA (n=15) or TOF (n=9). Serum alanine aminotransferase (ALT) and HCV viral load were measured before and 1 year after treatment initiation. Over 70% of ABA- and TCZ-treated patients were biologic-naïve.No significant differences were observed in serum ALT between baseline and 1 year after treatment between each treatment group. HCV replication was significantly lower in ABA-treated patients with RA. However, viral loads before and 1 year after TCZ and TOF treatment were comparable. As the results indicate that TOF might not increase HCV viral replication, this could have important implications for treatment decision-making.No major safety concerns were noted for RA patients with HCV infection receiving TCZ, ABA and TOF; with HCV viral activity unaffected during the treatment of these patients. With this in mind, the authors encourage the collaboration between rheumatologists and hepatologists to monitor viral loads and consider the suitability of direct antiviral therapy in HCV-infected RA patients.