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Hepatitis B virus reactivation in HB s A g‐positive patients with rheumatic diseases undergoing anti‐tumor necrosis factor therapy or DMARD s
Author(s) -
Lee Young Ho,
Bae SangCheol,
Song Gwan Gyu
Publication year - 2013
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12154
Subject(s) - medicine , etanercept , hbsag , infliximab , adalimumab , psoriatic arthritis , hepatitis b virus , rheumatoid arthritis , entecavir , gastroenterology , lamivudine , hepatitis b , ankylosing spondylitis , immunology , tumor necrosis factor alpha , virus
Objective The aim of this study was to assess the effects of anti‐tumor necrosis factor ( TNF ) agents or disease‐modifying antirheumatic drugs ( DMARD s) on hepatitis B virus ( HBV ) reactivation in hepatitis B surface antigen ( HB s A g)‐positive patients with rheumatic diseases. Methods Evidence of HBV reactivation after anti‐ TNF therapy or DMARD s in HB s A g‐positive patients with rheumatic disease was summarized by performing a systematic review. Results A total of 122 HB sAg‐positive rheumatic disease‐positive patients undergoing treatment with an anti‐ TNF agent or with DMARD s were identified in nine studies. In eight of the studies, the anti‐ TNF agents used were etanercept in 56 cases, adalimumab in 25 cases and infliximab in 14 cases. Follow‐up periods ranged from 6 to 52 months. Antiviral prophylaxis was administrated in 48 of the 122 patients (39.3%). HBV reactivation in HB sAg‐positive patients taking an anti‐ TNF agent or DMARD was reported in 15 cases (15/122 = 12.3%). Ten of the 15 patients provided individual data on HBV reactivation: four patients had rheumatoid arthritis, four had ankylosing spondylitis and two had psoriatic arthritis; four received etanercept, and two received infliximab. In one of the four etanercept‐treated cases in which the patient had elevated HBV ‐ DNA levels, antiviral prophylaxis was also administered. Antiviral treatment was also administered in seven patients receiving other treatments: lamivudine in one, adefovir in one and entecavir in five. Clinical outcomes were satisfactory in all 10 cases of HBV reactivation. Conclusions Hepatitis B virus reactivation was found in 15 (12.3%) patients among the 122 HB sAg‐positive patients with rheumatic diseases treated with anti‐ TNF agents or DMARD s.