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.
S. M. Jung,
H. K. Min,
J. H. Koh,
J. Y. Kang,
S. K. Kwok,
J. H. Ju,
H. J. Ko,
K. S. Park,
H. Y. Kim,
S. H. Park,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reactivation-of-hepatitis-b-virus-in-patients-with-rheumatoid-arthritis-after-anti-tnf-therapy/