ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 486

Safety Of Biologic Therapy In Veterans With Rheumatoid Arthritis and Chronic Hepatitis B Infection

Jeffrey R. Curtis1, Mary J. Burton2, Shuo Yang3, Lang Chen4, Ted R. Mikuls5, Kevin L. Winthrop6 and John Baddley7, 1University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL, 2VA Hospital, Jackson, MS, 3Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 4Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 5Omaha VA Medical Center and University of Nebraska Medical Center, Omaha, NE, 6Dept of Infectious Disease, Oregon Health & Science University, Portland, OR, 7Medicine, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Hepatitis, infection and rheumatoid arthritis (RA)

  • Tweet
  • Email
  • Print
Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Among patients with rheumatoid arthritis and hepatitis B infection, the impact of biologic therapy on hepatotoxicity has received limited study.

Methods: Using 1997-2011 national data from the U.S. Veteran’s Health Administration, we identified a cohort of 38,453 rheumatologist-diagnosed RA patients.  Patients who had hepatitis B infection (defined by detectable hepatitis B surface antigen, hepatitis B core antibody or hepatitis B DNA), initiated a new biologic (anti-TNF: infliximab, adalimumab, etanercept; vs. rituximab) that they had never been on previously and had a baseline ALT < 1.5x the upper limit of laboratory normal within 90 days prior to starting biologic therapy were eligible for analysis.  Patients could contribute more than one biologic treatment episode provided they switched to a new biologic they had not previously used, or switched to a previously used biologic they had not used in the past year. The main outcome of interest was hepatotoxicity, defined as ALT elevation > 100 IU/L (corresponding to 3x ULN for women and 2.5 ULN for men).  Hepatotoxicity was examined within the first year of biologic use.  Current exposure was defined as-treated based on day supply (injection biologics) or usual dosing intervals (infused biologics).  Results were reported as the cumulative incidence of patients achieving pre-defined hepatotoxicity at 3, 6 and 12-months post biologic exposure.

Results: 248 RA patients with hepatitis B were identified and contributed 322 new biologic treatment episodes.  Mean age was 60.2 years and 91.7% were male. Overall, ALT elevations were uncommon, with 10 hepatotoxicity events (ALT > 100 IU/L) occurring among 322 episodes (3.1%) within 12-months.  Most hepatotoxicity events (7/10, 70%) occurred within 90 days of initiation of biologic. The highest proportion of hepatotoxicity occurred in patients receiving rituximab (4/35, 11.4%) (p = 0.013 vs. anti-TNF).

Table:  RA patients with Hepatitis B and hepatotoxicity within 12 months of initiating biologics

Drug

Pts

Episodes

3-month Failures

6-month Failures

12-month Failures

ADA

122

126

1 (0.8%)

2 (1.6%)

2 (1.6%)

ETA

126

128

3 (2.3%)

4 (3.1%)

4 (3.1%)

INF

30

33

0 (0.0%)

0 (0.0%)

0 (0.0%)

RIT

25

35

3 (8.6%)

3 (8.6%)

4 (11.4%)

Total

248

322

7 (2.2%)

9 (2.8%)

10 (3.1%)

ABA=abatacept; ADA=adalimumab; ETA=etanercept; INF=infliximab; RIT=rituximab

Conclusion:    In US Veterans with hepatitis B receiving biologic therapy for RA, the proportion of episodes of hepatotoxicity (ALT >100 IU/L after initiation of biologic) was low, with the highest incidence occurring in patients receiving rituximab.  Among those who failed, most failures occurred early (<91 days) after biologic initiation. 


Disclosure:

J. R. Curtis,

Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, Abb Vie,

2,

Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, Abb Vie,

5;

M. J. Burton,
None;

S. Yang,
None;

L. Chen,
None;

T. R. Mikuls,

Roche/Genentech and Biogen IDEC Inc.,

2;

K. L. Winthrop,

Pfizer Inc,

2,

Genentech Inc., Pfizer, UCB, Regeneron,

5;

J. Baddley,

BMS,

2,

Pfizer Inc,

2.

  • Tweet
  • Email
  • Print

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/safety-of-biologic-therapy-in-veterans-with-rheumatoid-arthritis-and-chronic-hepatitis-b-infection/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology