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- Title
Safety of Biologic and Nonbiologic Disease-modifying Antirheumatic Drug Therapy in Veterans with Rheumatoid Arthritis and Hepatitis C Virus Infection.
- Authors
Burton, Mary Jane; Curtis, Jeffrey R.; Shuo Yang; Lang Chen; Singh, Jasvinder A.; Mikuls, Ted R.; Winthrop, Kevin L.; Baddley, John W.; Yang, Shuo; Chen, Lang
- Abstract
<bold>Objective: </bold>To examine the effect of disease-modifying antirheumatic drug (DMARD) therapy on hepatotoxicity among patients with rheumatoid arthritis (RA) and hepatitis C virus (HCV) infection.<bold>Methods: </bold>We identified biologic and nonbiologic treatment episodes of patients with RA using the 1997-2011 national data from the US Veterans Health Administration. Eligible episodes had HCV infection (defined by detectable HCV RNA) and subsequently initiated a new biologic or nonbiologic DMARD. Cohort entry required a baseline alanine aminotransferase (ALT) < 66 IU/l and quantifiable HCV RNA within 90 days prior to starting biologic/DMARD therapy. The primary outcome of interest was hepatotoxicity, defined as ALT elevation ≥ 100 IU/l or increase in HCV RNA of 1 log or more, and was examined within the first year of biologic/DMARD use. Results were reported as the cumulative incidence of treatment episodes achieving predefined hepatotoxicity at 3, 6, and 12 months after biologic/DMARD initiation.<bold>Results: </bold>RA patients with HCV (n = 748) were identified and contributed 1097 biologic/DMARD treatment episodes. Overall, ALT elevations were uncommon, with 37 (3.4%) hepatotoxicity events occurring within 12 months. Treatment episodes with biologic DMARD demonstrated more frequency of hepatotoxicity than did nonbiologic DMARD (4.8% vs 2.3%, p = 0.03). Among treatment episodes involving hepatotoxicity events, the majority occurred within 6 months of DMARD initiation (29/37, 78%).<bold>Conclusion: </bold>In US veterans with HCV and RA receiving biologic and nonbiologic DMARD, the frequency of hepatotoxicity (ALT ≥ 100 IU/l) was low, with a higher frequency observed in treatment episodes with current biologic use.
- Subjects
BIOTHERAPY; ANTIRHEUMATIC agents; BIOLOGICAL products; HEPATITIS C; VETERANS; RESEARCH funding; RHEUMATOID arthritis; RETROSPECTIVE studies; ARTHRITIS Impact Measurement Scales; DISEASE complications
- Publication
Journal of Rheumatology, 2017, Vol 44, Issue 5, p565
- ISSN
0315-162X
- Publication type
journal article
- DOI
10.3899/jrheum.160983