Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received conventional disease-modifying antirheumatic drugs
Clinical Rheumatology, 05/04/2012
Tan J et al. – It would be rational to initiate antiviral prophylaxis according to risk stratification rather than universal prophylaxis for hepatitis B virus (HBV)–infected rheumatoid arthritis (RA) patients. Conventional disease–modifying antirheumatic drugs (DMARDs) are relatively safe to HBV–infected patients with low reactivation risk.Methods
- A total of 476 RA patients were screened in this prospective non–randomized, non–controlled study.
- HBV–infected patients characterized by hepatitis B surface antigen (HBsAg) positive or HBsAg negative/anti–hepatitis B core antigen (anti–HBc) positive were analyzed for HBV DNA, followed with HBV DNA monitoring scheduled every 3 months, serum alanine aminotransferase test at 2–month intervals, or more frequently.
- Prevalence of HBsAg positive and HBsAg negative/anti–HBc positive was 6.51 and 51.1 %, respectively, among the 476 RA patients.
- Among 211 patients (23 patients were HBsAg positive and 188 patients were HBsAg negative/anti–HBc positive) who received c–DMARDs without antiviral prophylactic treatment, 4 patients developed HBV reactivation.
- Both HBsAg positive and HBsAg negative/anti–HBc positive patients have the possibility of developing HBV reactivation.
- There was no correlation between HBV reactivation and any specific c–DMARD.
- Glucocorticoid coadministration and negative anti–hepatitis B surface antigen (anti–HBs) at baseline showed correlation with reactivation.