Background/Purpose: Prophylactic anti-viral therapy is required in patients with hepatitis B virus (HBV) infection receiving biologics because of the high risk of HBV reactivation. However, it is unclear when to start biologics after anti-viral prophylaxis. We investigated the risk of HBV reactivation according to the timing of biologics initiation after anti-HBV prophylaxis in IMID patients with HBV infection.

Methods: We retrospectively evaluated the incidence of HBV reactivation in IMID patients who received biologics between July 2005 and April 2020. The patients were divided into two groups (“within 1-week ” vs. “after 1-week”) according to the timing of biologics initiation after anti-HBV prophylaxis. The cumulative probabilities and factors associated with HBV reactivation were evaluated.

Results: A total of 60 hepatitis B surface antigen-positive patients with IMID received biologics (within 1-week group, n = 23 [38%]; after 1-week group, n = 37 [62%]). During a median follow-up of 34 months (interquartile range, 20–74), three (5%) patients developed HBV reactivation. In the univariate analysis, the timing of biologics after HBV prophylaxis was not significantly associated with the risk of HBV reactivation (hazard ratio, 0.657; 95% confidence interval, 0.059–7.327; p = 0.733). The cumulative probabilities of HBV reactivation did not significantly differ according to the timing of biologics as well (p = 0.731).

Conclusion: The risk of HBV reactivation was not significantly associated with the timing of biologics administration after anti-HBV prophylaxis. Thus, biologics may be initiated early in patients with IMID under prophylactic treatment for HBV.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-hepatitis-b-virus-reactivation-in-patients-with-immune-mediated-inflammatory-diseases-receiving-biologics-focus-on-the-timing-of-biologics-after-prophylactic-anti-viral-agents/