Vol.21 No.6

Case Report

A patient with rheumatoid arthritis treated with tocilizumab together with lamivudine prophylaxis after remission of infliximab-reactivated hepatitis B

Authors

Hideki Tsuboi1 , Akira Tsujii2 , Akihide Nampei2 , Harumasa Yoshihara3 , Kiyoshi Kawano4 , Eiji Takeuchi5 , Kenrin Shi5

  • Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
  • Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
  • Department of Gastroenterology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
  • Department of Clinical Pathology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
  • Department of Orthopaedic Surgery, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka, 543-8922, Japan
  • Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
Received:

7 December 2010

Accepted:

6 May 2011

Published online:

29 May 2011

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Abstract

A 59-year-old woman with rheumatoid arthritis was treated quite successfully with infliximab, but her serum aminotransferase levels were markedly elevated; this was diagnosed as acute exacerbation of hepatitis B and she was treated with lamivudine, and infliximab was discontinued. The rheumatoid arthritis disease activity was uncontrollable after the discontinuation of infliximab, and we therefore initiated tocilizumab treatment (after obtaining the patient’s informed consent) together with lamivudine prophylaxis. After tocilizumab administration her rheumatoid arthritis disease activity was significantly attenuated, and the activity has remained low, without re-exacerbation of the hepatitis, for more than 2 years since the initiation of the tocilizumab.

Key words

Hepatitis B - Infliximab - Lamivudine - Rheumatoid arthritis - Tocilizumab