Hepatitis reactivation in patients with rheumatic diseases after immunosuppressive therapy—a report of long-term follow-up of serial cases and literature review

• Published in: Clinical rheumatology Vol. 33; no. 4; pp. 577 - 586
• Main Authors: Xuan, Dandan, Yu, Yiqi, Shao, Linyun, Wang, Jiali, Zhang, Wenhong, Zou, Hejian
• Format: Journal Article
• Language: English
• Published: London Springer London 01.04.2014; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Antiviral Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Azathioprine - therapeutic use; Case Based Review; Cohort Studies; Dermatomyositis - complications; Dermatomyositis - drug therapy; Female; Hepatitis B virus; Hepatitis B virus - physiology; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; Humans; Immunosuppressive Agents - therapeutic use; Literature reviews; Lupus Erythematosus, Cutaneous - complications; Lupus Erythematosus, Cutaneous - drug therapy; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Prednisone - therapeutic use; Rheumatic Diseases - complications; Rheumatic Diseases - drug therapy; Rheumatology; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Virus Activation; Young Adult; Steroid; Tumor necrosis factor-alpha-blocking agent; Disease-modifying anti-rheumatic drugs; Hepatitis B; Rheumatic disease
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-013-2450-9

The aims of this paper are to report hepatitis B virus reactivation in 12 patients with rheumatic disease undergoing immunosuppressive therapy and to evaluate whether pre-emptive antiviral therapy is necessary in patients receiving disease-modifying anti-rheumatic drugs. From January 2008 to March 2012, a total of 12 HBV-infected patients with rheumatic diseases were consecutively enrolled in the long-term follow-up. Liver function, HBV DNA, and serum aminotransferase level were tested during the follow-up. We also reviewed the published reports and summarized the clinical characteristics of HBV reactivation during immunosuppressive therapy in patients with rheumatic diseases. The medium duration of follow-up was 41 months (range 16–48). Patients were treated with prednisone, disease-modifying anti-rheumatic drugs (DMARDs) or tumor necrosis factor-alpha-blocking agents (TNFBA). HBV reactivation was only documented in two patients treated with prednisone without pre-emptive antiviral therapy. One hundred patients from literature review were identified as having HBV reactivation; 20.8 % of the patients receiving prednisone experienced HBV reactivation compared to only 4.46 and 9.52 % of patients treated with DMARDs or TNFBA, respectively. This long-term follow-up of serial cases suggests that pre-emptive antiviral therapy should be administered in patients receiving prednisone therapy for rheumatic disease. In contrast, DMARDs and TNFBA are relatively safe to HBV-infected patients with rheumatic diseases. Close monitoring of HBV DNA and ALT levels is necessary in the management of HBV reactivation.