Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Hepatitis B Virus Reactivation in Rheumatoid Arthritis and Ankylosing Spondylitis Patients Using Anti-TNF Agents: A Retrospective Analysis of 52 Cases with or without Anti-Viral Prophylaxis.

Ryu5,  Han Hee, Lee5,  Eun Young, Shin4,  Kichul, Choi5,  In Ah, Kim5,  Chul, Lee5,  Yoon Jong, Yoo7,  Bin

Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Division of Rheumatology, Department of Internal Medicine Pusan National University Hospital Institutes, Busan, Korea
Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Jeonju, Korea
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, Republic of
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
Divsion of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Divsion or Rheumatology, Department of Internal Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea

Background:

Anti-TNFa agents are widely used in the treatment of inflammatory arthritis such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). However, TNFa is also an important mediator contributing to the normal host immune response against infectious agents, in particular intracellular microorganisms. It is noteworthy that there are a number of case reports describing hepatitis B virus (HBV) reactivation in otherwise asymptomatic carriers under anti-TNFa treatment. Nevertheless, there is no established consensus describing whether this subset of patients would benefit from HBV anti-viral prophylaxis.

Objectives:

To investigate the incidence and characteristics of HBV reactivation in HBsAg carriers with RA and AS after initiating anti-TNFa agents.

Methods:

We retrospectively collected clinical data from 52 cases of HBsAg carriers with RA or AS who initiated anti-TNFa treatment at 7 centers nationwide. Periodic data of liver function tests and HBV DNA titers were utilized to assess HBV reactivation by 1) elevated HBV DNA level by >=1 log10 compared with baseline, and 2) increase of AST or ALT above 2 times of the upper normal limit at the same period. YMDD mutation was checked in lamivudine-treated patients who developed HBV reactivation.

Results:

Four patients were excluded from the analysis (three with high baseline transaminase, one died due to hepatocellular carcinoma). Among the 48 patients, 19 patients began anti-viral prophylaxis (14 lamivudine, 5 entecavir) with or shortly after starting anti-TNFa treatment. The remainder 29 patients without prophylaxis were treated with anti-viral agents if needed at the discretion of the clinician. The median duration of anti-TNFa treatment was 72 weeks in both groups. Of the 29 patients who did not receive primary prophylaxis, 2 patients (6.9 %) developed viral reactivation within a year of anti-TNFa treatment. In the prophylaxis group, 1 patient developed viral reactivation (5.2 %) at week 64 of anti-TNFa therapy. This single case of viral reactivation among the prophylaxis group was owing to YMDD mutation under lamivudine. There was not one case of reactivation in 5 patients who received entecavir as primary prophylaxis during the study period.

Conclusions:

The rate of HBV reactivation in patients under anti-TNFa therapy without anti-viral prophylaxis was 6.9 % among the study population. Anti-viral prophylaxis did help preventing HBV reactivation, except for 1 case of YMDD mutation after using lamivudine. A larger prospective study is warranted to elucidate whether long-term anti-viral prophylaxis would be crucial in HBsAg carriers starting anti-TNFa treatment.

To cite this abstract, please use the following information:
Ryu, Han Hee, Lee, Eun Young, Shin, Kichul, Choi, In Ah, Kim, Chul, Lee, Yoon Jong, et al; Hepatitis B Virus Reactivation in Rheumatoid Arthritis and Ankylosing Spondylitis Patients Using Anti-TNF Agents: A Retrospective Analysis of 52 Cases with or without Anti-Viral Prophylaxis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :387
DOI: 10.1002/art.28156

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