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- Title
Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Undergoing Biologics Treatment.
- Authors
Ming-Han Chen; Ming-Huang Chen; Chun-Yu Liu; Chang-Youh Tsai; De-Feng Huang; Hsiao-Yi Lin; Mei-Hsuan Lee; Yi-Hsiang Huang; Chen, Ming-Han; Chen, Ming-Huang; Liu, Chun-Yu; Tsai, Chang-Youh; Huang, De-Feng; Lin, Hsiao-Yi; Lee, Mei-Hsuan; Huang, Yi-Hsiang
- Abstract
<bold>Background: </bold>Immunosuppressants can induce hepatitis B virus (HBV) reactivation; however, informative data about the risk of different immunosuppressive regimens, including biologics, on HBV reactivation (HBVr) among patients with rheumatoid arthritis (RA) are incomplete.<bold>Methods: </bold>Among 2334 RA patients who had available hepatitis B surface antigen (HBsAg) data, 123 patients positive for HBsAg who were not receiving anti-HBV prophylaxis were enrolled. These patients were undergoing varied mono or combination immunosuppressive therapy, including 36 who were receiving biological disease-modifying antirheumatic drugs (bDMARDs).<bold>Results: </bold>During 3459 person-months of follow-up, 30 (24.4%) patients developed HBVr. The multivariate Cox proportional hazard models showed that glucocorticoid significantly increased the risk of HBVr. Among all kinds of immunosuppressive treatments, glucocorticoid in combination with bDMARDs and synthetic disease-modifying antirheumatic drugs (sDMARDs) had the highest risk of HBVr (adjusted hazard ratio [HR] = 5.14; 95% confidence interval [CI] = 1.77-14.92; P = .003). Rituximab had the greatest risk for HBVr (adjusted HR = 16.51; 95% CI = 1.82-149.67; P = .01) among the patients who received bDMARDs.<bold>Conclusions: </bold>Glucocorticoid has a detrimental effect on HBVr in RA patients. Antiviral prophylactic strategies should be justified according to the risk of HBVr under different combinations of immunosuppressive therapy in rheumatic patients.
- Subjects
IMMUNOSUPPRESSIVE agents; HEPATITIS B virus; RHEUMATOID arthritis; BIOLOGICALS; GLUCOCORTICOIDS; PATIENTS
- Publication
Journal of Infectious Diseases, 2017, Vol 215, Issue 4, p566
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiw606