BackgroundThe safety of newer non anti-TNF biologic agents [abatacept (ABA), tocilizumab (TCZ) and rituximab (RTX)] in patients with autoimmune rheumatic diseases and past HBV infection [defined as HBsAg(−), anti-HBc(+), anti-HBs(±)] has not been firmly established.ObjectivesTo assess the safety [reactivation of hepatitis B virus (HBV)] of non anti-TNF biologic agents in patients with serologic evidence of past HBV infection in real-life clinical settings.MethodsRetrospective chart review of patients followed in the Department of Rheumatology of the University Hospital of Crete. Patients who received ABA, TCZ or RTX during the period 2005–2015 and were HBsAg(−), anti-HBc(+), anti-HBs(±) at baseline were identified and reviewed for cases of HBV reactivation (defined as increased ALT accompanied by an increase of serum HBV DNA levels by >1 log10 compared with baseline or a switch in HBV DNA detection from negative to positive). Changes in anti-HBs titers during biologic therapy in patients who were anti-HBs(+) at baseline were also documented.Results83 different cases of non anti-TNF biologic therapy (34 ABA, 26 RTX and 23 TCZ) from 58 patients (56 RA - 2 ANCA-associated vasculitis) were identified. 64 cases (77.1%) were anti-HBc(+) anti-HBs(+) and 19 (22.9%) were anti-HBc(+) anti-HBs(−). Mean (SD) age at disease diagnosis and at non anti-TNF initiation was 53.6 (13.1) and 63.4 (9.2) years, respectively. All cases with RA had received prior anti-TNF agents [mean (SD) number of anti-TNF agents 1.1 (0.8)]. During treatment with non anti-TNF, concomitant synthetic disease modifying drugs or glucocorticoids were received by 91.5% and 46.3% of cases, respectively. Only 7 cases (8.4%) received antiviral prophylaxis concomitant with non anti-TNF treatment (4 with lamivudine - 3 with entecavir). After a mean (SD) of 41.9 (24.6) months of follow-up and a mean (SD) of 18.0 (15.9) therapy cycles, one anti-HBc(+) anti-HBs(−) case experienced HBV reactivation 12 months after treatment with abatacept and was treated with tenofovir with good outcome. Of anti-HBs(+) patients at baseline, titers of anti-HBs antibodies did not show statistically significant delay from baseline to most recent follow-up (456.9 mIU/ml vs. 390.7 mIU/ml, respectively, p=0.08) (Figure 1).Figure 1ConclusionsOne case of HBV reactivation underlines the need for diligent monitoring in patients with serologic evidence of past HBV infection receiving non anti-TNF biologic agents. More data are needed to determine the need for universal prophylactic antiviral therapy in this subset of patients.Disclosure of InterestNone declared
Background: Systemic Sclerosis (SSc) is a rare, multisystemic connective tissue disease associated with significant morbidity. Early recognition of patients at risk for adverse prognosis may help towards optimized monitoring and treatment, thus improving disease outcome. Objective: To correlate nailfold videocapillaroscopy (NVC) findings ('early', 'active', 'late' scleroderma patterns and non-specific capillary abnormalities) with major organ involvement and prognosis in patients with systemic sclerosis (SSc). Methods: Patients from the Scleroderma cohort followed at the Rheumatology clinic of the University Hospital of Heraklion will be included. The study will include a prospective and a retrospective part. Prospective part: All newly diagnosed patients will undergo NVC at baseline and subsequently every six months. We will review demographics, clinical features and autoantibodies status. Major organ involvement will be monitored (Pulmonary Function Test, DLCO, heart echocardiogram, chest XR, modified Rodnan skin score) at baseline and then every 6-12 months. Retrospective part: Existing SSc patients with available NVC data at diagnosis will be included. We will correlate the NVC findings at the time of diagnosis with disease outcomes such as major organ involvement, end stage organ failure, need for hospitalization, and death. We will also correlate longitudinal changes of the NVC patterns with treatment responses and outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.