Few patients starting biologics, DMARDs screened for HBV, HCV
ATLANTA — Less than a quarter of patients in a national rheumatology registry were screened for hepatitis B or C prior to initiating biologics or a new synthetic DMARDs, despite their potential increased risk for viral hepatitis reactivation, according to data presented at the 2019 ACR/ARP Annual Meeting.
“When we prescribe biologic medications, there is always a risk for reactivation of latent infections, specifically hepatitis B and tuberculosis,” Gabriela Schmajuk, MD, MS, of the University of California, San Francisco, and the San Francisco VA Medical Center, told Healio Rheumatology. “We were interested in looking at the proportion of patients in the RISE registry who had been screened for these latent infections prior to starting their biologic drugs.”
To evaluate pretreatment screening for hepatitis B and C virus among new users of biologics or new synthetic DMARDs, Schmajuk and colleagues studied data from the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE). According to the researchers, RISE is a national rheumatology registry based on electronic health records passively collected from 1,257 providers at 236 participating practices, representing approximately 36% of the U.S. clinical rheumatology workforce.
Schmajuk and colleagues included 23,597 adult patients from 196 practices with at least one prescription for a biologic or new synthetic DMARD between Jan. 1, and Dec. 31, 2017. The index date was defined as the first prescription date. New medication users were identified as those with two or more visits in the 12 months prior to their index date without any biologic or new synthetic DMARD use.
Patients were deemed to have a “complete” hepatitis B screening if both HBV surface antigen and core antibody were documented, with a “partial” screening defined as just one documented test. Complete hepatitis C screening was defined as a documented antibody or viral load test.
Schmajuk and colleagues studied screening across various time windows, including prior to the index date, during a 60-day grace period following the index date, and up to 1 year following the index date. In addition, they evaluated practice-level performance for those who reported on at least 20 patients.
According to the researchers, 22.8% patients had any documented screening for hepatitis B, while 14.4% received a documented screening for hepatitis C. Among patients with a complete hepatitis B test, 82.6% were performed prior to the index date. A total of 96.9% of patients completed a screening within 60 days of their index date. The researchers found similar patterns for hepatitis C screening. Among the 168 practices included in the practice-level analysis, median performance was 0% for both hepatitis B and C screening, and 0% for the composite screening measure.
“I think that we all believe that we are doing an excellent job taking care of our patients, but what we found is that there is a gap in care around screening for these infections,” Schmajuk said. “It is possible that we are not capturing all of the testing that was done, but we found really large gaps in this testing, which suggests it is not all due to documentation. These are such important safety issues. If people are not screened and they have a latent infection for hepatitis B, and they, for example, receive rituximab, they are at a significant risk for fulminant hepatic failure, which can result in death.”
“We actually looked to see, among the patients who were screened, how many had a positive test, and we found a rate of about 2% to 3% — so it is not insignificant,” she added. “If we can prevent one of those people from reactivating, that is going to save all of the money that we spent in screening them.” – by Jason Laday
Schmajuk G. Abstract #314. Pretreatment screening for hepatitis B and C among users of biologics or new synthetic disease modifying drugs: An analysis using RISE data. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Schmajuk reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.