ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 484

Reactivation of Hepatitis B Virus in Patients with Rheumatoid Arthritis after Anti-TNF Therapy

Seung Min Jung1, Hong Ki Min1, Jung Hee Koh1, Jin Young Kang1, Jennifer Lee1, Seung-Ki Kwok2, Ji Hyeon Ju1, Hyeok-Jae Ko3, Kyung-Su Park4, Ho-Youn Kim1 and Sung-Hwan Park1, 1Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, 2Division of Rheumatology, Department of Internal Medicine, St. Mary’s hospital, The Catholic University of Korea, Seoul, South Korea, 3Division of Rheumatology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea, 4Internal Medicine, St. Vincent Hospital, SuWon Gyeonggi-do, South Korea

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy: Safety of Biologics and Small Molecules in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Anti-TNF therapy was known to increase the risk of certain infection. There are only limited data about the reactivation of hepatitis B virus (HBV) after anti-TNF therapy. The study was aimed to investigate the clinical course of hepatitis B in patients with rheumatoid arthritis (RA) after the introduction of anti-TNF therapy.

Methods: We retrospectively reviewed to identify patients infected with HBV treated with TNF inhibitors between October, 2004 and September, 2013.  For patients with HBV infection, the liver enzyme and the viral status were monitored. The HBV reactivation was defined according to the Korean guideline by hepatology.

Results: Of 536 patients who were treated with TNF inhibitors, 17 patients had comorbidities of HBV infection.  Thirteen patients were treated with etanercept, three with adalimumab, and one with infliximab. Seven patients received pre-emptive antiviral prophylaxis before anti-TNF therapy: 4 with entecavir, 1 with telbivudine, 1 with tenofovir, and 1 with lamivudine. Among 17 patients with HBV infection, 4 (23.5 %) patients experienced the reactivation of HBV, which occurred in 3 patients without prophylaxis and 1 patient with lamivudine prophylaxis. In the latter case, YMDD mutation was identified and addition of adefovir resulted in virological response. The other three patients were treated successfully with entecavir or tenofovir. There was no subsequent events associated with HBV infection.

Conclusion: This study indicates the risk of HBV reactivation during anti-TNF therapy. Careful management is mandatory for patients who planned to be treated with TNF inhibitors.

Disclosure:

S. M. Jung,
None;

H. K. Min,
None;

J. H. Koh,
None;

J. Y. Kang,
None;

J. Lee,
None;

S. K. Kwok,
None;

J. H. Ju,
None;

H. J. Ko,
None;

K. S. Park,
None;

H. Y. Kim,
None;

S. H. Park,
None.

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