Fulminant Liver Failure due to Hepatitis B Reactivation During Treatment With Tocilizumab

ABSTRACT Tocilizumab is a humanized monoclonal antibody targeting the interleukin-6 receptor that is frequently used for the treatment of refractory rheumatoid arthritis. Since patients with hepatitis B virus (HBV) infection were excluded from pivotal trials, the risk of HBV reactivation with this novel drug class remains uncertain. We present the first case of tocilizumab-associated HBV reactivation resulting in fulminant hepatic failure and a need for liver transplant. Our findings underscore the need for prophylactic antiviral therapy in patients being treated with novel immunosuppressive agents.

[1]  G. Sourvinos,et al.  Liver safety of non-tumour necrosis factor inhibitors in rheumatic patients with past hepatitis B virus infection: an observational, controlled, long-term study. , 2018, Clinical and experimental rheumatology.

[2]  L. Scott.  Tocilizumab: A Review in Rheumatoid Arthritis , 2017, Drugs.

[3]  A. Geier,et al.  Toxic drug-induced liver failure during therapy of rheumatoid arthritis with tocilizumab subcutaneously: a case report. , 2017, Rheumatology.

[4]  L. Dai,et al.  Short‐course tocilizumab increases risk of hepatitis B virus reactivation in patients with rheumatoid arthritis: a prospective clinical observation , 2017, International journal of rheumatic diseases.

[5]  S. Kaneko,et al.  Cytomegalovirus Reactivation Induced Acute Hepatitis and Gastric Erosions in a Patient with Rheumatoid Arthritis under Treatment with an Anti-IL-6 Receptor Antibody, Tocilizumab. , 2016, Internal medicine.

[6]  Yu-feng Yuan,et al.  IL-6 Plays a Crucial Role in HBV Infection , 2015, Journal of clinical and translational hepatology.

[7]  Yanning Liu,et al.  Involvement of Interleukin 6 in Hepatitis B Viral Infection , 2015, Cellular Physiology and Biochemistry.

[8]  O. Fardel,et al.  Interleukin 6 inhibits HBV entry through NTCP down regulation. , 2015, Virology.

[9]  Yoshiya Tanaka,et al.  Case of severe liver damage after the induction of tocilizumab therapy for rheumatoid vasculitis , 2011, Hepatology research : the official journal of the Japan Society of Hepatology.

[10]  Mong-Liang Chen,et al.  HBV replication is significantly reduced by IL-6 , 2009, Journal of Biomedical Science.

[11]  T. Nagashima,et al.  Long-term tocilizumab therapy in a patient with rheumatoid arthritis and chronic hepatitis B. , 2008, Rheumatology.