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Risk of Hepatitis B Virus Reactivation in Patients With Inflammatory Arthritis Receiving Disease‐Modifying Antirheumatic Drugs: A Systematic Review and Meta‐Analysis
Author(s) -
Lin TzuChieh,
Yoshida Kazuki,
Tedeschi Sara K.,
Abreu Mirhelen Mendes,
Hashemi Nikroo,
Solomon Daniel H.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23346
Subject(s) - medicine , hepatitis b virus , psoriatic arthritis , meta analysis , rheumatoid arthritis , arthritis , hepatitis b , hbsag , confidence interval , immunology , gastroenterology , virus
Objective To assess hepatitis B virus ( HBV ) reactivation rates in patients with resolved or chronic HBV infection, receiving disease‐modifying antirheumatic drugs ( DMARD s) and with or without antiviral prophylaxis. Methods We conducted a systematic review and meta‐analysis. Electronic searches were conducted in PubMed, Medline, and Embase using Ovid through December 31, 2015. A search strategy was developed for each database using the following inclusion criteria: for participants, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and resolved or chronic HBV infection; for intervention, tumor necrosis factor ( TNF ) inhibitors or non‐ TNF biologic or nonbiologic DMARD s; and for outcome, HBV reactivation. Four reviewers independently extracted study data and assessed study quality using the Newcastle‐Ottawa Scale. To determine the pooled HBV reactivation rate, the variances of the raw proportions were stabilized using a Freeman‐Tukey‐type arcsine square root transformation, using a random‐effects model. Results Twenty‐five studies met the inclusion criteria. The overall pooled rate of HBV reactivation was 1.6% (95% confidence interval [95% CI ] 0.8–2.6) in patients with resolved HBV . Similar rates were observed in resolved patients taking TNF inhibitors (1.4% [95% CI 0.5–2.6]), non‐ TNF biologics (6.1% [95% CI 0.0–16.6]), and nonbiologic DMARD s (1.7% [95% CI 0.2–4.2]). We also found that the reactivation rate was lower in patients with chronic HBV infection who received antiviral prophylaxis (9.0% [95% CI 4.1–15.5]) than in those who did not (14.6% [95% CI 4.3–29.0]). Conclusion We found that the HBV reactivation rate in inflammatory arthritis patients receiving DMARD s was low in resolved patients and moderate in patients with chronic HBV infection. Further, lower rates were observed in patients with chronic HBV infection who were using antiviral prophylaxis.