Moderate Risk of Hepatitis B Virus Reactivation in HBsAg−/HBcAb+ Carriers Receiving Rituximab for Rheumatoid Arthritis

Kuo, Meng Hsuan; Tseng, Chih‐Wei; Lee, Chi-Hui; Tung, Chien-Hsueh; Tseng, Kuo‐Chih; Lai, Ning‐Sheng

doi:10.1038/s41598-020-59406-4

Cited by 41 publications

(42 citation statements)

References 29 publications

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“…Rituximab appears to have the highest risk; one retrospective study showed that in 50 RA patients at risk for reactivation, four developed HBV reactivation, two of whom developed clinically significant hepatitis and one died as a result of their illness. 48 There does not seem to be a significant difference in risk of reactivation with nonrituximab biologics or methotrexate therapy. 49 Considering these risks of reactivations, the American Gastroenterology Association (AGA) and the American College of Rheumatology recommend routine screening for patients with RA treated with immunosuppressives.…”

Section: Hepatitis Bmentioning

confidence: 97%

Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

Riley

George

2021

RMD Open

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Immunomodulatory therapy for rheumatoid arthritis (RA) carries risk for infectious complications. Understanding the risks of different therapeutic options is essential for making treatment decisions and appropriately monitoring patients. This review examines data on the risks for serious infections and other key infections of interest for the major classes of agents in use for RA: glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologics and Janus kinase (JAK) inhibitors. Conventional synthetic DMARDs have an excellent safety profile with recent data available supporting the relative safety of methotrexate. Tumour necrosis factor (TNF) inhibitors are associated with an increase in the risk of serious infections. Risk with other biological agents and with JAK inhibitors varies somewhat but overall appears similar to that of TNF inhibitors, with JAK inhibitors also associated with a greater risk of herpes zoster. Glucocorticoids have a dose-dependent effect on serious infection risk—at higher doses risk of infection with glucocorticoids is substantially greater than with other immunomodulatory therapies, and even low-dose therapy carries a risk of infection that appears to be similar to that of biological therapies.

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Section: Hepatitis Bmentioning

confidence: 97%

Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

Riley

George

2021

RMD Open

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“…In the current cohort, the highest HBV reactivation rate (100%) was noted. HBV reactivation was determined by the HBV serologic status [ 7 , 37 , 38 ], host immune status, treatment duration, glucocorticoid comedication [ 17 ], and history of bDMARD use [ 5 , 39 ]. In the current study, all HBsAg+ patients underwent comedication with glucocorticoids and had a history of bDMARD use.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study from Taiwan revealed that the incidence of HBV reactivation under rituximab treatment was up to 40% and 100% in HBsAg+ RA patients without or with steroid treatment [ 17 ]. Our previous report demonstrated that the incidence of HBV reactivation was up to 60% and 8% in HBsAg+ or HBsAg-/anti-HBc+ RA patients treated with rituximab [ 5 ]. According to the policy of National Health Insurance in Taiwan, RA patients with a poor response to rituximab should wait 6 months after the last dose of rituximab before switching to another biological agent.…”

Section: Discussionmentioning

confidence: 99%

“…Schwaneck et al noted that a history of treatment with three or more bDMARDs was present among more anti-HBc+ patients with than without reactivation ( P = 0.017) [ 39 ]. Previous report from our group demonstrated that a history of TNF-alpha inhibitor use was associated with HBV reactivation in HBsAg-/anti-HBc+ patients receiving rituximab [ 5 ]. Because of the low number of reactivation cases and the high number of cases with a history of bDMARDs treatment, our study cannot clarify the association between previous biological use and HBV reactivation.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Undergoing Tocilizumab-Containing Treatment

Kuo

Tseng

et al. 2021

Dig Dis Sci

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“…3 In rheumatoid arthritis (RA), HBV can be reactivated by changes in the disease course and by drug use. [4][5][6][7] In ammatory arthritis patients receiving biologic disease-modifying antirheumatic drugs (bDMARDs) are thought to have a moderate risk (1-10%) of hepatitis B reactivation. 7 A previous study reports that without antiviral prophylaxis, HBV reactivation occurs in 62.5% of HBV carriers and 25% of patients with occult HBV infection undergoing treatment with tumor necrosis factor -alpha blockers.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B virus Reactivation in Patients Receiving Tocilizumab for Rheumatoid Arthritis: A Long‐term, Retrospective Observational Study

Kuo

Tseng²,

et al. 2020

Preprint

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Aim To investigate the risk of hepatitis B virus (HBV) reactivation in patients undergoing long-term tocilizumab (TCZ) therapy for rheumatoid arthritis (RA). Method From January 2011 through August 2019, a total of 134 RA patients who received TCZ at Dalin Tzu Chi Hospital were screened. Patients were excluded if they were < 20 years, without complete data, or received TCZ for less than 3 months. A total of 97 patients were enrolled in this retrospective study. Clinical data, co-medications, and the occurrence of HBV reactivation were recorded. Results Of the 97 enrolled patients, 7 were HBsAg+ (7.2%), 64 were HBsAg−/HBcAb+ (61%) and 26 were HBsAg−/HBcAb+ (26.8%). The median disease follow-up time was 9 years (range, 1–18 years). TCZ was administered for a median of 29 months (range, 3–91 months). Four patients (4.1%) experienced HBV reactivation after TCZ therapy. Of the 7 HBsAg+ patients, 4 received antiviral prophylaxis and had no HBV reactivation; the remaining 3 patients had no antiviral prophylaxis, and all 3 (100%) experienced early HBV reactivation and hepatitis flare (median time to event, 6 months; range, 5–8 months). Hyper-bilirubinemia occurred in 2 of these 3 patients, with mild prothrombin time prolongation in one. After salvage entecavir treatment, all patients had a favorable outcome. Of the 64 HBsAg−/HBcAb+ patients, only one became positive for serum HBV DNA (2.5 × 10 7 IU/mL) after 18 months of TCZ treatment (1.6%; 1/64). This patient was immediately treated with entecavir, which prevented hepatitis flare. Conclusions HBsAg+ RA patients undergoing TCZ treatment are at high risk of HBV reactivation, which is prevented by antiviral prophylaxis. HBsAg−/HBcAb+ patients also are at risk of HBV reactivation. Although their risk of reactivation is lower than that of HBsAg+ patients, strict monitoring of their HBV status is still necessary.

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Moderate Risk of Hepatitis B Virus Reactivation in HBsAg−/HBcAb+ Carriers Receiving Rituximab for Rheumatoid Arthritis

Cited by 41 publications

References 29 publications

Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

Risk of Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Undergoing Tocilizumab-Containing Treatment

Hepatitis B virus Reactivation in Patients Receiving Tocilizumab for Rheumatoid Arthritis: A Long‐term, Retrospective Observational Study

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