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ÇÖZÜLMÜŞ HEPATİT B ENFEKSİYONLU VE ROMATİZMAL HASTALIĞI OLAN BİREYLERDE RİTUKSİMAB KULLANIMININ HEPATİT B REAKTİVASYONU ÜZERİNE ETKİSİ: TEK MERKEZLİ BİR ÇALIŞMA

Year 2024, Volume: 12 Issue: 2, 692 - 701, 20.06.2024
https://doi.org/10.33715/inonusaglik.1467613

Abstract

Hepatit B enfeksiyonu önemli morbidite ve mortaliteye sahip küresel bir hastalıktır. Bu çalışma, çeşitli romatolojik hastalıkların tedavisinde rituksimab kullanan çözülmüş HBV enfeksiyonlu hastalarda HBV reaktivasyon sıklığını değerlendirmeyi amaçlamaktadır. Romatolojik hastalıkların tedavisi için rituksimab tedavisi alan hastalar serolojik HBV enfeksiyon belirteçleri (HBV DNA, HBsAg, anti-HBc IgG ve anti-HBs) açısından retrospektif olarak tarandı. Çalışmaya HBV DNA negatif, HBsAg negatif ve anti-HBc IgG düzeyleri pozitif olan çözülmüş HBV enfeksiyonlu 25 hasta dahil edildi. Hastalardan 22’si kadın (%88), 3’ü erkek (%12) idi. Hastaların yaş ortalaması 62.56±9.786 idi. 25 hastanın 22’si romatoid artrit hastası, ikisi Sjögren sendromu iken bir hasta sistemik lupus eritamatozus hastasıydı. 15 hastada anti-HBs pozitif iken 10 hastada anti-HBs negatifti. Hastaların tedavi öncesi ortalama HBsAg titresi 0.27±0.102 iken anti-HBs titresi 211.00±317.380 IU/L idi. Çalışmaya dahil edilen hastaların hiçbirinde hepatit B reaktivasyonu gözlenmedi. Bu veriler, romatolojik hastalıkları olan hastaların rituksimab tedavisi altında HBV enfeksiyonunun reaktivasyon riskinin düşük olduğu göstermektedir. Ancak kesin sonuçlara varmak için prospektif, daha fazla hastanın dahil olduğu, çok merkezli çalışmalara ihtiyaç duyulmaktadır.

Ethical Statement

Çalışma, Helsinki Bildirgesi ve İyi Klinik Uygulama İlkeleri'ne uygun olarak gerçekleştirildi. İnönü Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alındı (Tarih: 22.01.2021 ve Karar No: 1126).

Supporting Institution

yok

Project Number

Tarih: 22.01.2021 ve Karar No: 1126

Thanks

Çalışmaya dahil edilen hastaların takip ve tedavisine dahil olan tüm sağlık çalışanlarına teşekkür ederiz.

References

  • Barone, M., Notarnicola, A., Lopalco, G., Viggiani, M. T., Sebastiani, F., Covelli, M., …Cantarini, L. (2015). Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection. Hepatology, 62(1), 40-46.
  • Barone, M., Venerito, V., Paolillo, R., Emmi, G., Fornaro, M., Cacciapaglia, F., …Lopalco, G. (2022). Long-term safety of rituximab in rheumatic patients with previously resolved hepatitis B virus infection. Internal and Emergency Medicine, 17(2), 475-480.
  • Bergantini, L., d’Alessandro, M., Cameli, P., Vietri, L., Vagaggini, C., Perrone, A., …Bargagli, E. (2020). Effects of rituximab therapy on B cell differentiation and depletion. Clinical Rheumatology, 39, 1415-1421.
  • Caballero, A., Tabernero, D., Buti, M. ve Rodriguez-Frias, F. (2018). Hepatitis B virus: The challenge of an ancient virus with multiple faces and a remarkable replication strategy. Antiviral Research, 158, 34-44.
  • Chen, Y. M., Chen, H. H., Huang, W. N., Chen, Y. H., Hsieh, T. Y., Yang, S. S., …Chen, D. Y. (2019). Reactivation of hepatitis B virus infection following rituximab treatment in HBsAg‐negative, HBcAb‐positive rheumatoid arthritis patients: A long‐term, real‐world observation. International Journal of Rheumatic Diseases, 22(6), 1145-1151.
  • Chiu, Y.-M. ve Chen, D.-Y. (2020). Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Review of Clinical Immunology, 16(2), 207-228.
  • Chuang, Y.-C., Tsai, K.-N. ve Ou, J.-H. J. (2022). Pathogenicity and virulence of Hepatitis B virus. Virulence, 13(1), 258-296.
  • Cohen, M. D. ve Keystone, E. (2015). Rituximab for rheumatoid arthritis. Rheumatology and Therapy, 2, 99-111.
  • Glebe, D., Goldmann, N., Lauber, C. ve Seitz, S. (2021). HBV evolution and genetic variability: Impact on prevention, treatment and development of antivirals. Antiviral research, 186, 104973.
  • Hsu, C., Tsou, H. H., Lin, S. J., Wang, M. C., Yao, M., Hwang, W. L., …Lin, J. (2014). Chemotherapy‐induced hepatitis B reactivation in lymphoma patients with resolved HBV infection: a prospective study. Hepatology, 59(6), 2092-2100.
  • Koutsianas, C., Thomas, K. ve Vassilopoulos, D. (2017). Hepatitis B reactivation in rheumatic diseases: screening and prevention. Rheumatic Disease Clinics, 43(1), 133-149.
  • Kuo, M. H., Tseng, C.-W., Lee, C.-H., Tung, C.-H., Tseng, K.-C. ve Lai, N.-S. (2020). Moderate risk of hepatitis B virus reactivation in HBsAg−/HBcAb+ carriers receiving rituximab for rheumatoid arthritis. Scientific Reports, 10(1), 2456.
  • Lan, T.-Y., Lin, Y.-C., Tseng, T.-C., Yang, H.-C., Kao, J.-H., Cheng, C.-F., …Li, K.-J. (2023). Risk of hepatitis b virus (HBV) reactivation in HBsAg-negative, anti-HBc-Negative patients receiving rituximab for autoimmune diseases in HBV endemic areas. Gut and Liver, 17(2), 288.
  • Marignani, M., Canzoni, M., D'Amelio, R., De Santis, E., Pecchioli, A. ve Delle Fave, G. (2011). Should we routinely treat patients with autoimmune/rheumatic diseases and chronic hepatitis B virus infection starting biologic therapies with antiviral agents? NO. European Journal of Internal Medicine, 22(6), 576-581.
  • Megahed, F. A. K., Zhou, X. ve Sun, P. (2020). The interactions between HBV and the innate immunity of hepatocytes. Viruses, 12(3), 285.
  • Mori, S. ve Fujiyama, S. (2015). Hepatitis B virus reactivation associated with antirheumatic therapy: risk and prophylaxis recommendations. World Journal of Gastroenterology: WJG, 21(36), 10274.
  • Ogawa, E., Wei, M. T. ve Nguyen, M. H. (2020). Hepatitis B virus reactivation potentiated by biologics. Infectious Disease Clinics, 34(2), 341-358.
  • Özkan, H. (2018). Epidemiology of chronic hepatitis B in Turkey. Euroasian Journal of Hepato-gastroenterology, 8(1), 73.
  • Paul, S., Dickstein, A., Saxena, A., Terrin, N., Viveiros, K., Balk, E. M. ve Wong, J. B. (2017). Role of surface antibody in hepatitis B reactivation in patients with resolved infection and hematologic malignancy: a meta‐analysis. Hepatology, 66(2), 379-388.
  • Perrillo, R. P., Gish, R. ve Falck-Ytter, Y. T. (2015). American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology, 148(1), 221-244. e223.
  • Seeger, C. ve Mason, W. S. (2015). Molecular biology of hepatitis B virus infection. Virology, 479, 672-686.
  • Smalls, D. J., Kiger, R. E., Norris, L. B., Bennett, C. L. ve Love, B. L. (2019). Hepatitis B virus reactivation: risk factors and current management strategies. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(12), 1190-1203.
  • Su, Y.-C., Lin, P.-C., Yu, H.-C. ve Wu, C.-C. (2018). Hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving chemotherapy or immunosuppressive therapy. European journal of Gastroenterology vehepatology, 30(8), 925-929.
  • Tien, Y.-C., Yen, H.-H. ve Chiu, Y.-M. (2017). Incidence and clinical characteristics of hepatitis B virus reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab for rheumatoid arthritis. Clin Exp Rheumatol, 35(5), 831-836.
  • Tokmak, S., Gümürdülü, Y., Taş, D. A., Kara, İ. O. ve Güzel, A. B. (2021). What is the risk of reactivation in patients with Resolved and Past HBV Infection during immunosuppressive therapy if HBV-DNA Negative before treatment? The Turkish Journal of Gastroenterology, 32(3), 294.
  • Tsai, Y.-F., Yang, C.-I., Du, J.-S., Lin, M.-H., Tang, S.-H., Wang, H.-C., …Dai, C.-Y. (2019). Rituximab increases the risk of hepatitis B virus reactivation in non-Hodgkin lymphoma patients who are hepatitis B surface antigen-positive or have resolved hepatitis B virus infection in a real-world setting: A retrospective study. PeerJ, 7, e7481.
  • Varisco, V., Viganò, M., Batticciotto, A., Lampertico, P., Marchesoni, A., Gibertini, P., …Todoerti, M. (2016). Low risk of hepatitis B virus reactivation in HBsAg-negative/Anti-HBc–positive carriers receiving rituximab for rheumatoid arthritis: a retrospective multicenter italian study. The Journal of Rheumatology, 43(5), 869-874.
  • World Health Organization (WHO/DSÖ). (18 July 2023). Hepatitis B, Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  • Wu, T., Wu, N., Ma, Y.-X., Wu, J., Gao, Y. ve Pan, X.-B. (2020). Role of hepatitis B antibody in predicting reactivation of resolved hepatitis B virus infection in leukemia patients. Antiviral Research, 177, 104765.
  • Zhang, J.-W., Zhang, X.-Z., Sun, Y.-L., Long, B., Wang, X.-Z. ve Li, X.-D. (2019). Reactivation of resolved hepatitis B virus infection combined with nephrotic syndrome in a patient after allogeneic haematopoietic stem cell transplantation. BMC Infectious Diseases, 19, 1-5.

Effect of Rituximab Use on Hepatitis B Reactivation in Individuals with Resolved Hepatitis B Infection and Rheumatic Disease: A Single Center Study

Year 2024, Volume: 12 Issue: 2, 692 - 701, 20.06.2024
https://doi.org/10.33715/inonusaglik.1467613

Abstract

Hepatitis B infection is a global disease with significant morbidity and mortality rates. This study aims to evaluate the frequency of HBV reactivation in patients with resolved HBV infection using rituximab for the treatment of various rheumatological diseases. Patients receiving rituximab therapy for the treatment of rheumatic diseases were retrospectively screened for serological HBV infection markers (HBV DNA, HBsAg, anti-HBc IgG and anti-HBs). Twenty-five patients with resolved HBV infection who were HBV DNA-negative, HBsAg-negative and anti-HBc IgG-positive were included in the study. Twenty-two patients were female (88%) and three were male (12%). The average age of the patients was 62.56±9.786 years. Out of 25 patients, 22 had rheumatoid disease, two had Sjögren's syndrome, and one patient had systemic lupus erythematosus. While anti-HBs was positive in 15 patients, anti-HBs was negative in 10 patients. The mean HBsAg titer of the patients before treatment was 0.27±0.102, while the anti-HBs titer was 211.00±317.380 IU/L. Hepatitis B reactivation was not observed in any of the patients included in the study. Hence, the data suggest that patients with rheumatological diseases have a low risk of reactivation of HBV infection under rituximab treatment. However, prospective, multicenter studies involving more patients are needed to reach definitive conclusions.

Project Number

Tarih: 22.01.2021 ve Karar No: 1126

References

  • Barone, M., Notarnicola, A., Lopalco, G., Viggiani, M. T., Sebastiani, F., Covelli, M., …Cantarini, L. (2015). Safety of long‐term biologic therapy in rheumatologic patients with a previously resolved hepatitis B viral infection. Hepatology, 62(1), 40-46.
  • Barone, M., Venerito, V., Paolillo, R., Emmi, G., Fornaro, M., Cacciapaglia, F., …Lopalco, G. (2022). Long-term safety of rituximab in rheumatic patients with previously resolved hepatitis B virus infection. Internal and Emergency Medicine, 17(2), 475-480.
  • Bergantini, L., d’Alessandro, M., Cameli, P., Vietri, L., Vagaggini, C., Perrone, A., …Bargagli, E. (2020). Effects of rituximab therapy on B cell differentiation and depletion. Clinical Rheumatology, 39, 1415-1421.
  • Caballero, A., Tabernero, D., Buti, M. ve Rodriguez-Frias, F. (2018). Hepatitis B virus: The challenge of an ancient virus with multiple faces and a remarkable replication strategy. Antiviral Research, 158, 34-44.
  • Chen, Y. M., Chen, H. H., Huang, W. N., Chen, Y. H., Hsieh, T. Y., Yang, S. S., …Chen, D. Y. (2019). Reactivation of hepatitis B virus infection following rituximab treatment in HBsAg‐negative, HBcAb‐positive rheumatoid arthritis patients: A long‐term, real‐world observation. International Journal of Rheumatic Diseases, 22(6), 1145-1151.
  • Chiu, Y.-M. ve Chen, D.-Y. (2020). Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Review of Clinical Immunology, 16(2), 207-228.
  • Chuang, Y.-C., Tsai, K.-N. ve Ou, J.-H. J. (2022). Pathogenicity and virulence of Hepatitis B virus. Virulence, 13(1), 258-296.
  • Cohen, M. D. ve Keystone, E. (2015). Rituximab for rheumatoid arthritis. Rheumatology and Therapy, 2, 99-111.
  • Glebe, D., Goldmann, N., Lauber, C. ve Seitz, S. (2021). HBV evolution and genetic variability: Impact on prevention, treatment and development of antivirals. Antiviral research, 186, 104973.
  • Hsu, C., Tsou, H. H., Lin, S. J., Wang, M. C., Yao, M., Hwang, W. L., …Lin, J. (2014). Chemotherapy‐induced hepatitis B reactivation in lymphoma patients with resolved HBV infection: a prospective study. Hepatology, 59(6), 2092-2100.
  • Koutsianas, C., Thomas, K. ve Vassilopoulos, D. (2017). Hepatitis B reactivation in rheumatic diseases: screening and prevention. Rheumatic Disease Clinics, 43(1), 133-149.
  • Kuo, M. H., Tseng, C.-W., Lee, C.-H., Tung, C.-H., Tseng, K.-C. ve Lai, N.-S. (2020). Moderate risk of hepatitis B virus reactivation in HBsAg−/HBcAb+ carriers receiving rituximab for rheumatoid arthritis. Scientific Reports, 10(1), 2456.
  • Lan, T.-Y., Lin, Y.-C., Tseng, T.-C., Yang, H.-C., Kao, J.-H., Cheng, C.-F., …Li, K.-J. (2023). Risk of hepatitis b virus (HBV) reactivation in HBsAg-negative, anti-HBc-Negative patients receiving rituximab for autoimmune diseases in HBV endemic areas. Gut and Liver, 17(2), 288.
  • Marignani, M., Canzoni, M., D'Amelio, R., De Santis, E., Pecchioli, A. ve Delle Fave, G. (2011). Should we routinely treat patients with autoimmune/rheumatic diseases and chronic hepatitis B virus infection starting biologic therapies with antiviral agents? NO. European Journal of Internal Medicine, 22(6), 576-581.
  • Megahed, F. A. K., Zhou, X. ve Sun, P. (2020). The interactions between HBV and the innate immunity of hepatocytes. Viruses, 12(3), 285.
  • Mori, S. ve Fujiyama, S. (2015). Hepatitis B virus reactivation associated with antirheumatic therapy: risk and prophylaxis recommendations. World Journal of Gastroenterology: WJG, 21(36), 10274.
  • Ogawa, E., Wei, M. T. ve Nguyen, M. H. (2020). Hepatitis B virus reactivation potentiated by biologics. Infectious Disease Clinics, 34(2), 341-358.
  • Özkan, H. (2018). Epidemiology of chronic hepatitis B in Turkey. Euroasian Journal of Hepato-gastroenterology, 8(1), 73.
  • Paul, S., Dickstein, A., Saxena, A., Terrin, N., Viveiros, K., Balk, E. M. ve Wong, J. B. (2017). Role of surface antibody in hepatitis B reactivation in patients with resolved infection and hematologic malignancy: a meta‐analysis. Hepatology, 66(2), 379-388.
  • Perrillo, R. P., Gish, R. ve Falck-Ytter, Y. T. (2015). American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology, 148(1), 221-244. e223.
  • Seeger, C. ve Mason, W. S. (2015). Molecular biology of hepatitis B virus infection. Virology, 479, 672-686.
  • Smalls, D. J., Kiger, R. E., Norris, L. B., Bennett, C. L. ve Love, B. L. (2019). Hepatitis B virus reactivation: risk factors and current management strategies. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(12), 1190-1203.
  • Su, Y.-C., Lin, P.-C., Yu, H.-C. ve Wu, C.-C. (2018). Hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving chemotherapy or immunosuppressive therapy. European journal of Gastroenterology vehepatology, 30(8), 925-929.
  • Tien, Y.-C., Yen, H.-H. ve Chiu, Y.-M. (2017). Incidence and clinical characteristics of hepatitis B virus reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab for rheumatoid arthritis. Clin Exp Rheumatol, 35(5), 831-836.
  • Tokmak, S., Gümürdülü, Y., Taş, D. A., Kara, İ. O. ve Güzel, A. B. (2021). What is the risk of reactivation in patients with Resolved and Past HBV Infection during immunosuppressive therapy if HBV-DNA Negative before treatment? The Turkish Journal of Gastroenterology, 32(3), 294.
  • Tsai, Y.-F., Yang, C.-I., Du, J.-S., Lin, M.-H., Tang, S.-H., Wang, H.-C., …Dai, C.-Y. (2019). Rituximab increases the risk of hepatitis B virus reactivation in non-Hodgkin lymphoma patients who are hepatitis B surface antigen-positive or have resolved hepatitis B virus infection in a real-world setting: A retrospective study. PeerJ, 7, e7481.
  • Varisco, V., Viganò, M., Batticciotto, A., Lampertico, P., Marchesoni, A., Gibertini, P., …Todoerti, M. (2016). Low risk of hepatitis B virus reactivation in HBsAg-negative/Anti-HBc–positive carriers receiving rituximab for rheumatoid arthritis: a retrospective multicenter italian study. The Journal of Rheumatology, 43(5), 869-874.
  • World Health Organization (WHO/DSÖ). (18 July 2023). Hepatitis B, Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  • Wu, T., Wu, N., Ma, Y.-X., Wu, J., Gao, Y. ve Pan, X.-B. (2020). Role of hepatitis B antibody in predicting reactivation of resolved hepatitis B virus infection in leukemia patients. Antiviral Research, 177, 104765.
  • Zhang, J.-W., Zhang, X.-Z., Sun, Y.-L., Long, B., Wang, X.-Z. ve Li, X.-D. (2019). Reactivation of resolved hepatitis B virus infection combined with nephrotic syndrome in a patient after allogeneic haematopoietic stem cell transplantation. BMC Infectious Diseases, 19, 1-5.
There are 30 citations in total.

Details

Primary Language Turkish
Subjects Preventative Health Care, General Practice
Journal Section Araştırma Makalesi
Authors

Esra Erdoğan 0000-0003-1626-6033

Mehmet Ali Erdogan 0000-0002-1713-5695

Servet Yolbaş 0000-0001-8516-9769

Muhammed Furkan Keser 0000-0002-4524-9761

Saliha Aydın 0000-0002-8118-2779

Project Number Tarih: 22.01.2021 ve Karar No: 1126
Early Pub Date June 3, 2024
Publication Date June 20, 2024
Submission Date April 11, 2024
Acceptance Date May 21, 2024
Published in Issue Year 2024 Volume: 12 Issue: 2

Cite

APA Erdoğan, E., Erdogan, M. A., Yolbaş, S., Keser, M. F., et al. (2024). ÇÖZÜLMÜŞ HEPATİT B ENFEKSİYONLU VE ROMATİZMAL HASTALIĞI OLAN BİREYLERDE RİTUKSİMAB KULLANIMININ HEPATİT B REAKTİVASYONU ÜZERİNE ETKİSİ: TEK MERKEZLİ BİR ÇALIŞMA. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 12(2), 692-701. https://doi.org/10.33715/inonusaglik.1467613