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

• Published in: Digestive diseases and sciences Vol. 66; no. 11; pp. 4026 - 4034
• Main Authors: Kuo, Meng Hsuan, Tseng, Chih-Wei, Lu, Ming-Chi, Tung, Chien-Hsueh, Tseng, Kuo-Chih, Huang, Kuang-Yung, Lee, Chi-Hui, Lai, Ning-Sheng
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2021; Springer; Springer Nature B.V
• Subjects: Adalimumab; Antiarthritic agents; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Arthritis; Arthritis, Rheumatoid - drug therapy; Biochemistry; Blood; Care and treatment; Disease prevention; Gastroenterology; Guanine - analogs & derivatives; Guanine - therapeutic use; Health aspects; Hepatitis B; Hepatitis B Antibodies - blood; Hepatitis B Surface Antigens - blood; Hepatitis B virus; Hepatitis B virus - physiology; Hepatitis B, Chronic - drug therapy; Hepatology; Humans; Immunosuppressive agents; Medical examination; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Monoclonal antibodies; Oncology; Original; Original Article; Prevention; Retrospective Studies; Rheumatoid arthritis; Rheumatoid factor; Risk Factors; Transplant Surgery; Virus Activation - drug effects; Virus Latency - drug effects; Tocilizumab; HBV reactivation; Hepatitis flare-up; Rheumatoid arthritis
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-020-06725-1

Background and Aim To investigate the risk of hepatitis B virus reactivation in patients undergoing long-term tocilizumab therapy for rheumatoid arthritis. Method From January 2011 through August 2019, a total of 97 patients were enrolled in this retrospective study. Clinical data, comedications, and the occurrence of HBV reactivation were recorded. Results Seven patients were HBsAg+ (7.2%), 64 were HBsAg−/HBcAb+ (65.9%), and 26 were HBsAg−/HBcAb− (26.8%). The median disease follow-up time was 9 years. TCZ was administered for a median of 29 months. Four patients (4.1%) experienced HBV reactivation after tocilizumab therapy. Of the 7 HBsAg+ patients, 4 received antiviral prophylaxis and had no HBV reactivation; the remaining 3 patients did not receive antiviral prophylaxis, and all 3 (100%) experienced HBV reactivation and hepatitis flare-up. Hyperbilirubinemia 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 tocilizumab treatment (1.6%; 1/64). This patient was immediately treated with entecavir, which prevented hepatitis flare-up. Conclusions Tocilizumab is widely used in treating rheumatoid arthritis and has the potential to reduce the mortality rate among severe COVID-19 patients. However, HBV reactivation needs to be considered. HBsAg+ patients have a high risk of HBV reactivation, which could be prevented by antiviral prophylaxis. Although the risk of reactivation is low in HBsAg−/HBcAb+ patients, strict monitoring is necessary.