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Reactivation of hepatitis B virus in rheumatoid arthritis patients treated with biological disease‐modifying antirheumatic drugs
Author(s) -
Nakamura Jun,
Nagashima Takao,
Nagatani Katsuya,
Yoshio Taku,
Iwamoto Masahiro,
Minota Seiji
Publication year - 2016
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.12359
Subject(s) - medicine , hepatitis b virus , etanercept , rheumatoid arthritis , tocilizumab , hepatitis b , gastroenterology , immunology , virus
Objective To examine the incidence of hepatitis B virus ( HBV ) reactivation in patients with rheumatoid arthritis ( RA ) receiving biological disease‐modifying antirheumatic drugs ( DMARD s). Methods We retrospectively reviewed RA patients treated with biological DMARDs at our institution from July 2010 to December 2012. Patients with antibodies for hepatitis B core antigen and/or hepatitis B surface antigen were regarded as having prior HBV infection. Clinical data on these patients, including HBV ‐ DNA levels, were retrieved from the medical records. Results During the study period, 251 patients were administered various biological DMARD s. Six patients with a history of HBV vaccination and one patient with positive HBV surface antigen were excluded from the study. Fifty‐seven of the remaining 244 patients (23.4%) had prior HBV infection. These patients were followed for a median of 18 months (range: 2–27 months) and HBV ‐ DNA was examined a median of seven times (range: 2–27). HBV ‐ DNA was detected in three patients (5.3%), comprising two receiving tocilizumab and one receiving etanercept. However, HBV ‐ DNA levels were below the quantitation limit (<2.1 log copies mL −1 ) in all three patients. HBV ‐ DNA became negative again within several months in all three patients, while biological DMARD s were continued and liver function tests remained normal throughout. Conclusion HBV ‐ DNA reactivation occurred in 5.3% of RA patients with prior HBV infection during treatment with biological DMARD s, but there were no associated clinical manifestations. Accordingly, it seems that biological DMARD s can be used safely in patients with RA .