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

Kuo, Meng Hsuan; Tseng, Chih‐Wei; Lu, Ming‐Chi; Tung, Chien-Hsueh; Tseng, Kuo‐Chih; Huang, Kuang-Yung; Lee, Chi-Hui; Lai, Ning‐Sheng

doi:10.1007/s10620-020-06725-1

Cited by 24 publications

(36 citation statements)

References 41 publications

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“…Relating to TNF- inhibitors and DAMARDs, data from Asia-Pacific regions demonstrated a HBVr risk of around 3.1% (range 1.1–5.2%) [ 30 – 32 ]. A recent Taiwanese study reported one (1.6%) out of 64 rheumatic patients receiving tocilizumab experienced HBVr [ 76 ]. Further studies are needed in these areas.…”

Section: Methodsmentioning

confidence: 99%

“…Disease-modifying antirheumatic drugs (bDMARDs/ sDMARDs) had a HBVr risk of around 22% (range 9-63%) among HBsAg-positive patients [31][32][33][34][35]. HBVr, hepatitis flare-up and even fulminant hepatic failure had been observed in HBsAg-positive rheumatic patients receiving tocilizumab, an IL-6 receptor monoclonal antibody [76,77]. Further studies are called upon in this field as anti-IL-6 was being used in the current COVID-19 pandemic in some parts of the world [78].…”

Section: Incidence Of Hbvr Treated With Immunosuppressive Agentsmentioning

confidence: 99%

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APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liver-related morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.

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Section: Methodsmentioning

confidence: 99%

Section: Incidence Of Hbvr Treated With Immunosuppressive Agentsmentioning

confidence: 99%

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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“…Our previous studies evaluated the HBV reactivation risk in RA patients who received rituximab and tocilizumab. 5,6 In these two studies, around 7%-8% of the study population were HBsAg+ patients, and HBcAb+ patients accounted for 62%-65% of the study F I G U R E 1 A flowchart for the rate of hepatitis B virus reactivation stratified by different HBV infection status in patients with rheumatoid arthritis treated with tofacitinib. Abbreviations: HBcAb, hepatitis B core antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; RA, rheumatoid arthritis population.…”

Section: Discussionmentioning

confidence: 99%

“…Physicians should carefully monitor these patients who still have a potential for HBsAg seroconversion. 6 Four patients with HBV reactivation were treated with multiple drugs including DMARDs, steroids and tofacitinib.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Our previous study demonstrated that RA patients using biologic agents, such as rituximab or tocilizumab, might experience HBV reactivation leading to acute hepatitis, hyperbilirubinemia, and even death. 5,6 Tofacitinib is a potent, selective Janus kinase (JAK) 1 and JAK3 inhibitor. It was initially approved for the treatment of RA, and thereafter for psoriatic arthritis and ulcerative colitis.…”

mentioning

confidence: 99%

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Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib

et al. 2021

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Hepatitis B virus (HBV) is a common viral infection in humans, and HBV infection is endemic in Taiwan. 1 Rheumatoid arthritis (RA) is characterized by chronic inflammation of the joints resulting in deformity and disability. Common medications for the treatment of RA include: (a) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs); (b) biologic agents, such as tumor necrosis factor inhibitors, abatacept, rituximab, tocilizumab; and (c) targeted synthetic DMARDs, such as tofacitinib, baricitinib,

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Management of hepatitis B virus reactivation due to treatment of COVID-19

et al. 2022

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The world has made significant progress in developing novel treatments for COVID-19 since the pandemic began. Some treatments target the patient’s dysregulated inflammatory response during COVID-19 infection and may cause hepatitis B reactivation (HBVr) in patients with current or past hepatitis B virus (HBV) infection. This review summarizes the risk and management of HBVr due to different treatments of COVID-19 in patients who have current or past HBV infection. Abnormal liver function tests are common during COVID-19 infection. Current evidence suggests that current or past HBV infection is not associated with an increased risk of liver injury and severe disease in COVID-19 patients. Among patients who received high-dose corticosteroids, various immunosuppressive monoclonal antibodies and inhibitors of Janus kinase, the risk of HBVr exists, especially among those without antiviral prophylaxis. Data, however, remain scarce regarding the specific use of immunosuppressive therapies in COVID-19 patients with HBV infection. Some results are mainly extrapolated from patients receiving the same agents in other diseases. HBVr is a potentially life-threatening event following profound immunosuppression by COVID-19 therapies. Future studies should explore the use of immunosuppressive therapies in COVID-19 patients with HBV infection and the impact of antiviral prophylaxis on the risk of HBVr.

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

Cited by 24 publications

References 41 publications

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib

Management of hepatitis B virus reactivation due to treatment of COVID-19

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