Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Hepatitis B virus (HBV) reactivation is a common complication of immunosuppressive treatment in countries with a high prevalence of HBV infection. Biologics – and especially Rituximab – seem to cause this adverse event more commonly than conventional forms of treatment do. However, it is unclear how often patients suffer from HBV reactivation in a low prevalence country like Germany when treated with biologics for rheumatic diseases.
Methods: Using an electronic database (EMIL©; version 4.7.6.19), we were able to digitally search the files of patients treated in our Rheumatology out-patient unit between April 2008 and May 2015 (10.019 patients in total). Patients on immunosuppressive therapy screened for HBV infection have been included in the analysis. Clinical data of all patients are summarized in table 1.
Results: Between April 2008 and May 2015, 1107 patients were treated with biologics in our Rheumatology/Immunology out-patient department, 378 of which received Rituximab at least once. Of the 1107 biologics patients, 59 (5%) tested HBc antibody positive, indicating prior infection with HBV. One patient (1/59) suffered from an active HBV infection (HBs antigen positive). Only 2/59 patients, including the chronically infected patient mentioned above, received prophylactic antiviral treatment. There were no obvious HBV reactivations and no incidents of liver failure due to HBV, although in 2 patients, traces of HBV DNA could newly be detected under treatment with Infliximab in one case, and Rituximab in another case. After antiviral treatment HBV DNA became undetectable again in both cases.
Conclusion: HBV reactivation during antirheumatic therapy with biologics is a relatively rare event in German patients. Whilst both screening for prior or chronic HBV infection and close monitoring of affected patients is mandatory, prophylactic antiviral treatment does not seem to be necessary in every detected case of prior HBV infection.
Table: Clinical data of the patients involved in the current analysis
|
Total number of patients treated with biologics between April 2008 and May 2015 included in this analysis |
1107
|
|
Number of patients receiving Rituximab at least once (not withstanding other biologic treatment). Reactivation under Rituximab |
378 1/378 |
|
Rheumatologic diagnosis |
Rheumatoid arthritis: 663 Psoriatic arthritis: 113 Spondyloarthritis: 140 Connective Tissue Diseases (CTD)/Myositis: 50 Vasculitis: 54 Other: 87 |
|
Hepatitis Bc antibody positive |
59 |
|
HBs antigen positive |
1 |
|
HBV DNA positive |
3
|
|
Reactivation with Rituximab Reactivation with non-Rituximab treatment |
1/378 (0,3%) 1/729 (0,1%) |
|
Antiviral treatment |
Preemptive: 2 After increase of HBV DNA: 2 |
|
Liver failure due to HBV infection |
0 |
To cite this abstract in AMA style:
Scharbatke EC, Kreissl-Kemmer S, Tony HP, Schmalzing M, Geier A. Reactivation of Hepatitis B-Infection in German Patients with Inflammatory Rheumatic Diseases Treated with Biologics – a Monocentric Analysis Involving 1107 Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/reactivation-of-hepatitis-b-infection-in-german-patients-with-inflammatory-rheumatic-diseases-treated-with-biologics-a-monocentric-analysis-involving-1107-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/reactivation-of-hepatitis-b-infection-in-german-patients-with-inflammatory-rheumatic-diseases-treated-with-biologics-a-monocentric-analysis-involving-1107-patients/