Examining the Seroprevalance and Antiviral Prophylaxis Rate of Hepatitis B and C Virus in Rheumatic Patients Treated with Biological and Targeted Synthetic Disease Modifying Anti-rheumatic Drugs: Results from a Tertiary Center in Central Anatolia
Öz
Objective: To evaluate the epidemiological characteristics of hepatitis B virus (HBV) and hepatitis C virus (HCV) in rheumatic patients treated with biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs).
Methods: This cross-sectional study was carried out between September 2021 and April 2022 at the Rheumatology Outpatient Clinic of Erciyes University Faculty of Medicine, and it included 200 patients [113 with axial spondyloarthritis (axSpA), 18 with psoriatic arthritis (PsA) and 69 with rheumatoid arthritis (RA)]. The demographic and clinical characteristics, treatment details and viral hepatitis serology of the patients were recorded. Those not receiving biological and/or targeted synthetic DMARDs (b/tsDMARDs) were excluded.
Results: The median age of the patients was 47 (39-58) years, and the median disease duration was 10 (7-15) years. 117 (58.5%) of the patients were female, and 83 (41.5%) were male. The median duration of treatment with b/tsDMARDs was 6 (2-9) years. In the viral serological examinations, 1.5% of the patients were positive for HBsAg, 64.5% for anti-HBs, 23.5% for anti-HBc IgG, and 0.5% for anti-HCV. The anti-HBc IgG positivity rate was significantly higher in RA (34.8%) than axSpA patients (16.8%) and was similar to PsA patients (22.2%) (p = 0.023). Yet HBsAg, anti-HBs, and anti-HCV serologies were similar across patient subgroups (p > 0.05). A total of 44 (22%) patients were undergoing oral antiviral prophylaxis. Three (1.5%) patients who were anti-HBc positive and HBV DNA negative were followed without antiviral treatment. There was no viral reactivation in any patient.
Conclusion: Approximately one in four patients in our cohort showed anti-Hbc positivity, and almost all of them were using antiviral prophylaxis. Anti-HCV prevalence was much lower. Studies addressing viral hepatitis in rheumatic patients and/or patient subgroups, both at the national and local level, will enable rheumatologists to be more effective in managing HBV and HCV.
Anahtar Kelimeler
Axial spondyloarthritis, HBV, HCV, psoriatic arthritis, rheumatoid arthritis
Etik Beyan
This study was approved by the Erciyes University Clinical Research Ethics Committee (Date:22 September 2021, Approval Number:2021/612). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all patients.
Kaynakça
- Wong PK, Bagga H, Barrett C, Chong G, Hanrahan P, Kodali T, et al. A practical approach to the use of conventional synthetic, biologic and targeted synthetic disease modifying anti-rheumatic drugs for the treatment of inflammatory arthritis in patients with a history of malignancy. Curr Rheumatol Rep 2018;20:1-13.
- Min HK, Kim SH, Kim H-R, Lee S-H. Therapeutic Utility and adverse effects of biologic disease-modifying anti-rheumatic drugs in inflammatory arthritis. Int J Mol Sci 2022;23(22):13913.
- Evangelatos G, Bamias G, Kitas GD, Kollias G, Sfikakis PP. The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022;42(9):1493-1511.
- Sarzi-Puttini P, Ceribelli A, Marotto D, Batticciotto A, Atzeni F. Systemic rheumatic diseases: from biological agents to small molecules. Autoimmun Rev 2019;18(6):583-592.
- Michelsen B, Fiane R, Diamantopoulos AP, Soldal DM, Hansen IJW, Sokka T, et al. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PloS One 2015;10(4):e0123582.
- Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19-34.
- Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, Campanholo CB, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 2022;18(8):465-479.
- Smolen JS, Landewé RB, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 2023;82(1):3-18.
- Cheah JT, Faragon JJ, Marks KM. Management of hepatitis B and C infections in rheumatologic disease. Best Practice & Research Clinical Rheumatology. 2018;32(6):848-68.
- Dağlı Ö, Aksoy MK. Hepatitis B and hepatitis C infection prevalence in ankylosing spondylitis patients. Ortadoğu Tıp Dergisi. 2018;10(3):297-301.