HBV reactivation in HBsAg-/HBcAb+ rheumatoid arthritis patients receiving biologic/targeted synthetic DMARDs.

Abstract

BACKGROUND:

Rheumatoid arthritis (RA) patients seropositive for hepatitis B core antibody (HBcAb) and negative for hepatitis B surface antigen (HBsAg) are at risk of hepatitis B virus (HBV) reactivation when treated with biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs). The study aims to investigate the risk in this population.

METHODS:

From January 2004 through December 2020, 1068 RA patients undergoing b/tsDMARDs therapy and 416 patients with HBsAg-/HBcAb+ were enrolled. Factors associated with HBV reactivation were analysed.

RESULTS:

During 2845 person-years of follow-up, 27 of 416 (6.5%,9.5 per 1000 person-years) patients developed HBV reactivation, with a cumulative rate of HBV reactivation of 3.5% at 5 years, 6.1% at 10 years and 24.2% at 17 years. The median interval from beginning b/tsDMARDs to HBV reactivation was 85 months (range: 9-186 months). The risk of HBV reactivation varied by type of b/tsDMARD, with rituximab having the highest risk (incidence rate: 48.3 per 1000 person-years), followed by abatacept (incidence rate: 24.0 per 1000 person-years). In multivariate analysis, rituximab (adjusted hazard ratio [aHR]: 15.77, 95% confidence interval [CI]: 4.12-60.32, p = .001), abatacept (aHR: 9.30, 1.83-47.19, p = .007), adalimumab (aHR: 3.86, 1.05-14.26, p = .04) and negative baseline HBV surface antibody (anti-HBs, <10 mIU/mL) (aHR: 3.89, 1.70-8.92, p < .001) were independent risk factors for HBV reactivation.

CONCLUSION:

HBsAg-/HBcAb+ RA patients are susceptible to HBV reactivation during b/tsDMARD therapy. Those with negative baseline anti-HBs and those on certain b/tsDMARDs, such as rituximab, abatacept and adalimumab, have high reactivation risks. Risk stratification and management should be based on the patient's baseline anti-HBs titre and type of therapy.

• Authors: Meng Hsuan Kuo, Chih-Wei Tseng, Ping-Hung Ko, Sz-Tsan Wang, Ming-Chi Lu, Chien-Hsueh Tung, Kuo-Chih Tseng, Kuang-Yung Huang, Chi-Hui Lee, Ning-Sheng Lai
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 44 Issue 2 Pg. 497-507 (Feb 2024) ISSN: 1478-3231 [Electronic] United States
• PMID: 38010984 (Publication Type: Journal Article)
• Copyright: © 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Hepatitis B Surface Antigens
• Rituximab
• Adalimumab
• Abatacept
• Antirheumatic Agents
• Hepatitis B Antibodies
• Biological Products

Topics

• Humans
• Hepatitis B virus
• Hepatitis B Surface Antigens
• Rituximab (adverse effects)
• Adalimumab (adverse effects)
• Abatacept (therapeutic use, pharmacology)
• Hepatitis B (drug therapy)
• Arthritis, Rheumatoid (drug therapy, complications)
• Antirheumatic Agents (adverse effects)
• Hepatitis B Antibodies
• Biological Products
• Virus Activation