Current antiviral practice and course of Hepatitis B virus infection in inflammatory arthritis: a multicentric observational study (A + HBV study)

Abstract

Objective: The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis. Material and Methods:Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection. Results:In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44±12 years, and the mean follow-up duration was 31±22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment).Conclusion: HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

“…Evidence suggests that HBV carriers (HBsAg-positive) would benefit from prophylactic treatment, and thus it is advised that they should be referred to hepatologist for antiviral prophylactic treatment. 114 115 As outlined in the SLR informing these recommendations, data are less robust for drugs [116][117][118][119][120][121][122][123][124][125] other than bDMARDs. [126][127][128][129][130][131][132][133][134][135][136] However, for non-bDMARDs users, referral to a hepatologist for consideration of anti-viral prophylaxis is also recommended.…”

Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

“…Data for prophylaxis are more robust for patients treated with bDMARDs 98–108 compared with other drug categories. 109–118 Coadministration of glucocorticoids has been identified as an additional risk factor. 111 115 117 119 120 Data from a meta-analysis show that reactivation was decreased in HBsAg-positive inflammatory arthritis patients who received antiviral prophylaxis compared with those who did not.…”

“…Several studies have shown that patients who are positive for HBsAg are at high risk for reactivation, on treatment with DMARDs or other immunosuppressants. Data for prophylaxis are more robust for patients treated with bDMARDs98–108 compared with other drug categories 109–118. Coadministration of glucocorticoids has been identified as an additional risk factor 111 115 117 119 120.…”

Tuberculosis and viral hepatitis infection in Eastern Europe, Asia, and Latin America: impact of tumor necrosis factor-α inhibitors in clinical practice

“… 74 , 75 To date, there are no large-scale prospective studies evaluating the risk of HBV reactivation in response to treatment with TNF-α inhibitors. A number of studies reported HBV reactivation, 76 – 83 whereas some studies reported otherwise. 53 , 58 , 71 , 84 Even in studies where reactivation was reported, prophylactic treatment with an antiviral agent appeared to prevent reactivation.…”