Discontinuation of antiviral prophylaxis correlates with high prevalence of hepatitis B virus (HBV) reactivation in rheumatoid arthritis patients with HBV carrier state: a real-world clinical practice

Abstract

BackgroundTo investigate the risk of hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients with HBV carrier state during treatment of disease-modifying antirheumatic drugs (DMARDs) and the use of antiviral prophylaxis in real-world clinical practice.MethodsConsecutive RA patients with HBV carrier state were included. Clinical data including liver evaluation, HBV infection evaluation and the use of antiviral prophylaxis were recorded.ResultsFifty-three RA patients with HBV carrier state were screened and 36 patients were qualified for analysis. Thirty-six percentage of patients developed HBV reactivation and 17% developed HBV hepatitis together with reactivation, one of which developed decompensate cirrhosis. Only 50% of patients accepted lamivudine although all patients were recommended antiviral prophylaxis with entecavir or tenofovir and only 31% continued during DMARDs therapy. Seventy-one percentage of patients who discontinued antiviral prophylaxis developed HBV reactivation 3 ~ 21 months after discontinuation. Logistic regression analyses showed discontinuation of antiviral prophylaxis (OR: 66, p = 0.027), leflunomide (OR: 64, p = 0.011) and past history of hepatitis (OR: 56, p = 0.013) were risk factors of HBV reactivation. Past history of hepatitis (OR: 10, p = 0.021) was also risk factor of HBV hepatitis together with reactivation.ConclusionOur results suggest poor patient acceptance and discontinuation of antiviral prophylaxis should not be ignored for Chinese RA patients with HBV carrier state in real-world clinical practice. Discontinuation of antiviral prophylaxis, past history of hepatitis and LEF might increase risk of HBV reactivation for RA patients with HBV carrier state during DMARDs therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-449) contains supplementary material, which is available to authorized users.

Risk of Hepatitis B Virus Reactivation in Patients With Inflammatory Arthritis Receiving Disease‐Modifying Antirheumatic Drugs: A Systematic Review and Meta‐Analysis

“…The characteristics of the included studies are shown in Table . The study design for most of the included studies was retrospective or prospective observational (n = 23), and 21 were conducted in a single‐center setting.…”

Hepatitis B virus reactivation in patients with rheumatoid arthritis: Analysis of the National Database of Japan

“…5 Patients with autoimmune diseases such as rheumatoid arthritis (RA) receiving immunosuppressive treatment are also considered to be a risk group. Nevertheless, to date, only case reports 6,7 or cohort studies with small sample sizes [8][9][10][11][12][13][14] have been conducted to investigate the risk of HBV reactivation in patients with RA receiving immunosuppressive therapy. Furthermore, no studies have been conducted to investigate the incidence of fulminant hepatitis due to HBV reactivation.…”

Reactivation of hepatitis B (HB) in rheumatoid arthritis patients who are HB carriers: A multicenter, prospective, observational study in Japan

“…Compared to a study in China on HB carriers with RA, HB reactivations or patients developing hepatitis after reactivation were less frequent in the present study. 3 Established antiviral effectiveness of entecavir was confirmed here, but the above definition of HB reactivation might not be unequivocal because serum HBV-DNA levels often fluctuate. Additionally, whether csDMARDs having almost no immunosuppressive activity can be a risk for HB reactivation still needs to be elucidated.…”

“…1,2 Reactivation of HB occurs in 8-36% of HB carriers with RA, especially in those not receiving prophylactic treatment with antiviral nucleos(t)ide analogues (NAs). 2,3 However, factors determining the risk of reactivation are not well established, and the effectiveness of NAs remains uncertain. Hence, to determine the incidence and risk of HB reactivation, we prospectively investigated HB carriers with RA in 14 hospitals throughout Japan from 2012 to 2017.…”

“…They were monitored at least every 3 months and HB reactivation was defined as a >10-fold increase in serum HB virus (HBV)-DNA. 2,3 The study was approved by the National Hospital Organization Central Research Ethics Committee.…”