The Frequency of Chronic and Occult Hepatitis B Infection in the Patients Receiving Biological DMARD Therapy and Treatment Management

Yıl 2022, Cilt: 6 Sayı: 1, 72 - 77, 28.04.2022

Asli Keles Onal Selda Sarıkaya Şenay Özdolap Çoban Ali Erdem Baki Fürüzan Köktürk

https://doi.org/10.29058/mjwbs.941637

Öz

Aim: We aimed to investigate the presence of hepatitis B virus (HBV) reactivation, chronic and occult
HBV in patients who are followed in the Physical Medicine and Rehabilitation Clinic of Zonguldak Bülent
Ecevit University Health Practice Research Hospital and using biological disease modifying drugs
(bDMARDs). Material and Methods: The data files of the patients with ongoing biological disease-modifying antirheumatic drug (bDMARD) therapy that
was followed by the Physical Medicine and Rehabilitation Clinic were analyzed retrospectively. Patient data such as age, gender, diagnosis,
medication and its duration, Hepatitis B antigens and antibodies (HBsAg, anti-HBs and anti-HBc IgG), and antiviral HBV treatments were
recorded.
Results: The study included 138 patients comprising 64 (46.4%) females and 74 (53.6%) males. The mean age was 47.7±11.9 years.
HBsAg, anti-HBc IgG, and anti-HBs positivity were detected in 4 (2.9%), 47 (34.8%), and 63 (45.6%) patients in our outpatient clinic,
respectively. Thirty-two (23.2%) of the patients were receiving antiviral treatment. Close HBV DNA monitoring was performed for 3 months
in 15 patients with (+) anti-HBc IgG, these patients were not followed by antiviral treatment. Totally 16 patients were vaccinated against
Hepatitis B.
Conclusion: As a consequence of the study, no HBV reactivation was encountered in the clinical follow-up of 47 patients with an ongoing
medication of meanly 5 years for chronic and occult HBV. We concluded that the development of a feared complication such as HBV
reactivation can be prevented in patients using bDMARDs with strict follow-up and appropriate protocol

Anahtar Kelimeler

Anti-tumor necrosis factor therapy, Biological DMARD, Hepatitis B virus reactivation, Rheumatic disease

Biyolojik DMARD Kullanan Hastalarda Kronik Hepatit B Enfeksiyonu ve Okkült Hepatit B Sıklığı ve Tedavi Yönetimi

Öz

Amaç: Biyolojik hastalık modifiye edici ilaç (bDMARDs) kullanan hastaların (romatoid artrit, ankilozan
spondilit ve psöriatik artrit) Hepatit B virüs (HBV) reaktivasyonu, kronik ve okkült HBV varlığını
araştırmayı hedefledik.
Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Sağlık Uygulama Araştırma Hastanesi
Fiziksel Tıp ve Rehabilitasyon kliniğinde takip edilen ve biyolojik DMARDs (infliksimab, adalimumab,
etanercept, golimumab, sertolizumab, tofasitinib, sekukinumab, tosilizumab, ustekinumab) kullanan
hastaların dosyalarında yer alan verileri retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, tanıları
(romatoid artrit, ankilozan spondilit ve psöriatik artrit), kullanmakta olduğu ilaçlar, kullanım süreleri,
Hepatit B antijen ve antikorları (HBsAg, anti-HBs ve anti-HBc IgG) ve HBV için ilaç kullanmakta olan
hastalar kaydedildi.
Bulgular: Çalışmaya 138 hasta dahil edildi. Hastaların 64’ü (%46,4) kadın ve 74’ü (%53,6) erkekti.
Ortalama yaşları 47,7±11,9 yıl olarak hesaplandı. Olguların dördünde (%2,9) HBsAg 47 (%34,8)’sinde
anti-HBc IgG ve 63 (%45,6)’ünde anti-HBs pozitifliği vardı. Hastaların 32 (%23,2)’si antiviral tedavi almaktaydı.
Anti HBc-Ig G(+) olan 15 (%10,8) olgu antiviral tedavisizdi ve üç aylık HBV DNA izlemleri ile
takip edilmekteydi. Toplam 16 (%11,5) olgu Hepatit B’ye karşı aşılıydı.
Sonuç: Çalışma sonucunda bDMARD kullanan kronik ve okkült HBV yönünden 47 olgunun ortalama
beş yıllık tedavi ve klinik izleminde HBV reaktivasyonu görülmedi. Biyolojik DMARDs kullananlarda sıkı
takip ve uygun protokolle HBV reaktivasyonu gibi korkulan bir komplikasyon gelişmeyebilir.

Anahtar Kelimeler

Anti-tümor nekrozis faktör tedavi, Biyolojik DMARD, Hepatit B reaktivasyon, Romatizmal Hastalıklar

Kaynakça

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