Prevalence of Hepatitis B Serology and Reactivation in Rheumatology Patients Receiving Biologic or Targeted Synthetic Disease-Modifying Antirheumatic Drugs

Year 2024, Volume: 6 Issue: 3, 542 - 545, 24.09.2024

Derya Çırakoğlu , Emine Serap Yılmaz

https://doi.org/10.37990/medr.1530674

Abstract

Aim: This study sought to assess hepatitis B virus (HBV) serology and the incidence of HBV reactivation (HBVr) in rheumatology patients with resolved hepatitis B infection (HBsAg negative and HBcAb positive) who were undergoing treatment with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs).
Material and Method: Data from rheumatology patients treated with b/tsDMARDs were retrospectively reviewed from the electronic records. The demographic data, the anti-rheumatic drugs used, and the hepatitis serologies (HBsAg, anti-HBc IgG, anti-HBs, and anti-HCV) of the patients were analyzed.
Results: The study included a total of 316 patients, of whom 217 (68.7%) were diagnosed with ankylosing spondylitis, 74 (23.4%) with rheumatoid arthritis, and 25 (7.9%) with psoriatic arthritis. Evaluation of the patients' viral serologies revealed that four (1.2%) were HBsAg positive, and 18 (5.7%) were HBsAg negative and HBcAb positive. Anti-HCV positivity was observed in one (0.3%) patient. All serologies were negative in 153 (48.4%) patients. No HBVr was detected during the follow-up of the patients.
Conclusion: The rate of resolved hepatitis B infection is relatively high in patients under rheumatologic follow-up. However, the use of biologics in these patients poses a low risk of HBVr.

Keywords

Biologic therapy, b/tsDMARD, hepatitis B virus reactivation, rheumatologic diseases

References

• Mihai IR. Viral B and C hepatitis in rheumatic patients under biological therapy. Revista Medico-Chirurgicala. 2022;126:511-9.
• Ozkan H. Epidemiology of Chronic Hepatitis B in Turkey. Euroasian J Hepatogastroenterol. 2018;8:73-4.
• Singh JA, Saag KG, Bridges SL, et al. 2015 American College of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68:1-26.
• Spera AM. Hepatitis B virus infection reactivation in patients under immunosuppressive therapies: pathogenesis, screening, prevention and treatment. World J Virol. 2022;11:275-82.
• Ridola L, Zullo A, et al. Hepatitis B (HBV) reactivation in patients receiving biologic therapy for chronic inflammatory diseases in clinical practice. Ann Ist Super Sanita. 2021;57:244-8.
• Kuo MH, Tseng CW, Lee CH, et al. Moderate risk of hepatitis B virus reactivation in HBsAg−/HBcAb+ carriers receiving rituximab for rheumatoid arthritis. Sci Rep. 2020;10:2456.
• Conway R, Doran MF, O’Shea FD, et al. The impact of hepatitis screening on diagnosis and treatment in rheumatoid arthritis. Clin Rheumatol. 2014;33:1823-7.
• Cholongitas E, Haidich AB, Apostolidou-Kiouti F, et al. Hepatitis B virus reactivation in HBsAg-negative, anti-HBc-positive patients receiving immunosuppressive therapy: a systematic review. Ann Gastroenterol. 2018;31:480-90.
• EASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167-85. J Hepatol. 2013;58:201.
• Ogawa E, Wei MT, Nguyen MH. Hepatitis B virus reactivation potentiated by biologics. Infect Dis Clin North Am. 2020;34:341-58.
• Kuo MH, Tseng C, Ko P, et al. HBV reactivation in HBsAg−/HBcAb+ rheumatoid arthritis patients receiving biologic/targeted synthetic DMARDs. Liver Int. 2024;44:497-507.
• Koutsianas C, Thomas K, Vassilopoulos D. Reactivation of hepatitis B virus infection in rheumatic diseases: risk and management considerations. Ther Adv Musculoskelet Dis. 2020;12:1759720X2091264.
• Fidan S, Capkın E, Arıca DA, et al. Risk of hepatitis B reactivation in patients receiving anti-tumor necrosis factor-α therapy. Int J Rheum Dis. 2021;24:254-9.
• Capkin E, Yazıcı A, Karkucak M, et al. Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study. Rheumatol Int. 2022;43:523-31.
• Ergenc I, Kani HT, Karabacak M, et al. Biologic therapy carries a very low risk of reactivation in hepatitis B surface antigen-negative phase of hepatitis B. Turk J Gastroenterol. 2023;34:156-60.
• Hong X, Xiao Y, Xu L, et al. Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta-analysis. Immun Inflamm Dis. 2023;11:e780.
• Demirpençe Ö, Şahin H, Gümüş A, et al. HbsAg and antiHCV seroprevalence in an Eastern province of Turkey. Cumhuriyet Medical Journal. 2016;38:29-34.
• Okay G, Biberci Keskin E, Akkoyunlu Y, et al. Evaluation of hepatitis B vaccine efficacy and factors affecting vaccine nonresponse in patients receiving anti-tumor necrosis factor agents. Eur J Gastroenterol Hepatol. 2021;33:1091-6.