HBV reactivation unlikely after biologic treatment for rheumatic diseases, inflammatory bowel disease
Hepatitis B reactivation following biologic therapy for rheumatic diseases or inflammatory bowel disease was unlikely, according to recently presented study findings.
A cohort of 934 patients with available Hepatitis B (HBV) serologies were studied, 710 of whom had rheumatic disease and 224 had inflammatory bowel disease. All patients were AgHBs-negative, and 72 patients (8.5%) were anti-HBc with an undetectable viral load. About two-thirds of the patients with anti-HBc were women, with a median disease duration of 6.6 years and a median age 54.1 years at the initiation of treatment with a biologic agent.
Sixty-one anti-HBc-positive patients were diagnosed with a rheumatic disease, with 31 patients diagnosed with rheumatoid arthritis, 12 patients diagnosed with ankylosing spondylitis and 10 patients diagnosed with psoriatic arthritis. Eleven patients had IBD, 10 patients had Crohn’s disease and one patient had ulcerative colitis.
In the anti-HBc-positive patients, the most commonly prescribed biologic was Remicade (infliximab, Janssen) in 38.9% of the patients, followed by Enbrel (etanercept, Amgen) in 31.9%, Humira (adalimumab, AbbVie) in 12.5%, and Simponi (golimumab, Janssen), Actemra (tocilizumab, Genentech) and Rituxan (rituximab, Genentech) each prescribed to 5.6% of the patients. Concomitant treatment with methotrexate was present in 44 patients; 43 patients were treated with other non-biologic disease-modifying anti-rheumatic drugs (DMARDs), and 51 patients received corticosteroids. Prophylactic antiviral therapy was not used by any of the patients, and discontinuation of a biologic during follow-up occurred in 5.6% of the patients.
Reactivation of HB occurred in one patient: a woman with Crohn’s disease and acute HBV in her history, according to the researchers. Initial treatment was with adalimumab and azathioprine. After poor response, the patient was switched to infliximab and was not anti-HB positive at the time. Thirteen months after inception of infliximab, HBV reactivation occurred. Infliximab as discontinued, and the patient recovered with antiviral therapy. – by Shirley Pulawski
Romao VC, et al. Paper #FRI0139. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.
Disclosure: The researchers report no relevant financial disclosures.