Hepatitis B virus reactivation associated with antirheumatic therapy: risk and prophylaxis recommendations

Accompanying the increased use of biological and non-biological antirheumatic drugs,a greater number of cases of hepatitis B virus(HBV) reactivation have been reported in inactive hepatitis B surface antigen(HBs Ag) carriers and also in HBs Ag-negative patients who have resolved HBV infection. The p...

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Published inWorld journal of gastroenterology : WJG Vol. 21; no. 36; pp. 10274 - 10289
Main Author Mori, Shunsuke
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 28.09.2015
Subjects
Antirheumatic Agents - adverse effects
Antiviral Agents - therapeutic use
Hepatitis
Hepatitis B - diagnosis
Hepatitis B - epidemiology
Hepatitis B - immunology
Hepatitis B - prevention & control
Hepatitis B - virology
Hepatitis B virus - drug effects
Hepatitis B virus - immunology
Hepatitis B virus - pathogenicity
Humans
Immunocompromised Host
Prevalence
Recurrence
Rheumatic Diseases - diagnosis
Rheumatic Diseases - drug therapy
Rheumatic Diseases - epidemiology
Rheumatic Diseases - immunology
Risk Assessment
Risk Factors
therapy;Resolved
Topic Highlight
Virus Activation - drug effects
virus;Antirheumatic
Reactivation
Resolved hepatitis B virus infection
Hepatitis B virus
Occult hepatitis B virus carrier
Antirheumatic therapy
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Summary:Accompanying the increased use of biological and non-biological antirheumatic drugs,a greater number of cases of hepatitis B virus(HBV) reactivation have been reported in inactive hepatitis B surface antigen(HBs Ag) carriers and also in HBs Ag-negative patients who have resolved HBV infection. The prevalence of resolved infection varies in rheumatic disease patients,ranging from 7.3% to 66%. Through an electronic search of the Pub Med database,we found that among 712 patients with resolved infection in 17 observational cohort studies,12 experienced HBV reactivation(1.7%) during biological antirheumatic therapy. Reactivation rates were 2.4% for etanercept therapy,0.6% for adalimumab,0% for infliximab,8.6% for tocilizumab,and 3.3% for rituximab. Regarding non-biological antirheumatic drugs,HBV reactivation was observed in 10 out of 327 patients with resolved infection from five cohort studies(3.2%). Most of these patients received steroids concomitantly. Outcomes were favorable in rheumatic disease patients. A number of recommendations have been established,but most of the supporting evidence was derived from the oncology and transplantation fields. Compared with patients in these fields,rheumatic disease patients continue treatment with multiple immunosuppressants for longer periods. Optimal frequency and duration of HBV-DNA monitoring and reliable markers for discontinuation of nucleoside analogues should be clarified for rheumatic disease patients with resolved HBV infection.
Bibliography:Shunsuke Mori;Shigetoshi Fujiyama;Department of Rheumatology,Clinical Research Center for Rheumatic Diseases,NHO Kumamoto Saishunsou National Hospital;Department of Hepatology and Gastroenterology,Kumamoto Shinto General Hospital
Accompanying the increased use of biological and non-biological antirheumatic drugs,a greater number of cases of hepatitis B virus(HBV) reactivation have been reported in inactive hepatitis B surface antigen(HBs Ag) carriers and also in HBs Ag-negative patients who have resolved HBV infection. The prevalence of resolved infection varies in rheumatic disease patients,ranging from 7.3% to 66%. Through an electronic search of the Pub Med database,we found that among 712 patients with resolved infection in 17 observational cohort studies,12 experienced HBV reactivation(1.7%) during biological antirheumatic therapy. Reactivation rates were 2.4% for etanercept therapy,0.6% for adalimumab,0% for infliximab,8.6% for tocilizumab,and 3.3% for rituximab. Regarding non-biological antirheumatic drugs,HBV reactivation was observed in 10 out of 327 patients with resolved infection from five cohort studies(3.2%). Most of these patients received steroids concomitantly. Outcomes were favorable in rheumatic disease patients. A number of recommendations have been established,but most of the supporting evidence was derived from the oncology and transplantation fields. Compared with patients in these fields,rheumatic disease patients continue treatment with multiple immunosuppressants for longer periods. Optimal frequency and duration of HBV-DNA monitoring and reliable markers for discontinuation of nucleoside analogues should be clarified for rheumatic disease patients with resolved HBV infection.
Hepatitis B virus;Antirheumatic therapy;Resolved h
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Correspondence to: Shunsuke Mori, MD, PhD, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan. moris@saisyunsou1.hosp.go.jp
Author contributions: All authors contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript and making critical revisions with regard to important intellectual content, and final approval of the manuscript.
Telephone: +81-96-2421000 Fax: +81-96-2422619
ISSN:1007-9327
2219-2840
2219-2840
DOI:10.3748/wjg.v21.i36.10274