ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2454

Virus Reactivation Rate in Rheumatoid Arthritis Using Tofacitinib

Yukitomo Urata, Rheumatology, Tsugaru General Hospital, United Municipalities of Tsugaru, Gosyogawara, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Although the increase in the incidence of Herpes Zoster by tofacitinib(TOF) in rheumatoid arthritis (RA) is well known, the reactivation rate of other viruses is unknown. We clarify the reactivation rate of varicella virus (VZV), hepatitis B virus (HBV), EB virus and cytomegalovirus (CMV) when using TOF for RA patients.

Methods: We measured VZVIgG, VZVIgM, high sensitivity HBs antigen, HBV-DNA, CMVIgG (EIA), CMVIgM (EIA), CMV antigenemer, EBV VCA IgG (EIA, FA) and EBV VCA IgM (EIA, FA) once every 3 months. Antigenemia positive, high sensitivity HBs antigen positive, IgG antibody raised by 4 times or more was defined as virus reactivation.

Results: 35 RA patients, 77% of women, 65 years of age, 10 years of disease duration, 74% positive for CCP antibody, SDAI 9.5, corticosteroid (PSL) use rate 14%, mean PSL 2.2 mg / day, MTX usage 23%, mean MTX dose 7.5 mg / week, TOF (average 8 mg / day) was administered on average for 12 months. Each virus reactivation rate was 2.9, 8.6, 25.5 and 0% for CMV, HBV, VZV and EBV, respectively. There were no cases where more than two types of virus reactivation came. As clinical symptoms CMV had fever, VZV showed all cases, eruption. No liver dysfunction was observed in HBV reactivation case. A significant difference (68.8 vs 29.7 p <0.05) was observed in the CMV IgG value between the cases of HBV reactivation and no other virus reactivation cases.

Conclusion: Viral reactivation by TOF administration in RA is diverse and its rate is high (37.1%) by highly sensitive virus examination and elaborate observation of body findings, However, it is possible to prevent the seriousness of virus reactivation by TOF by detailed examination and appropriate blood collection, early treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 1 Comparison of patient characteristics with or without varicella zoster virus reactivation

 

Reactivation (+)

Reactivation (-)

p

n

10

26

 

female(%)

90

73

0.2740

age(median)(IQR)

66 (59-68)

64 (58-68)

0.5022

disease duration(month)(mean)(95%CI)

183 (83-284)

153 (110-196)

0.5482

duration of administration of TOF(month)(mean)(95%CI)

20.8 (9.8-31.8)

12.5 (7.7-17.3)

0.0797

IgMRF positive(%)

80

62

0.2926

CCP positive(%)

80

69

0.5182

SDAI(Base)(median)(IQR)

14.3 (7.6-21.9)

9.1 (4.2-17.0)

0.2659

HAQ-DI(mean)(IQR)

0.7 (0.0-0.9)

0.3 (0.1-1.0)

0.9152

TOF dose(mg/day)(mean)(95%CI)

7.5 (5.6-9.4)

8.3 (7.3-9.2)

0.4030

PSL use(%)

10

15

0.6756

PSL dose(mg/day)(mean)(95%CI)

2.0

2.3 (0.2-4.3)

1.0000

MTX use(%)

20

27

0.6674

MTX dose(mg/wk)(mean)(IQR)

5.0 (5.0-10.0)

7.5 (2.5-10.0)

1.0000

CRP(mg/dL)(Last)(mean)(95%CI)

1.5 (0.0-2.9)

1.6 (0.7-2.6)

0.8735

MMP-3(mean)(95%CI)

203 (95-311)

172 (101-243)

0.4166

IgG(mean)(95%CI)

1371 (1224-1518)

1323 (1157-1489)

0.6236

sIL-2R(U/mL)(mean)(95%CI)

549 (401-696)

590 (430-749)

0.8266

WBC(/mm3)(mean)(95%CI)

2309 (4676-7980)

3130 (5550-8078)

0.9156

Lymphocyte(/mm3)(mean)(95%CI)

1480 (1216-1744)

1401 (1149-1653)

0.3227

HBV positive(%)

70

38.5

0.0896

HBsAb positive(%)

40

12

0.0533

HBsAb(median)(IQR)

18 (9.9-122.3)

9 (0.6-61.5)

0.4133

HBcAb positive(%)

40

23

0.3099

HBcAb(median)(IQR)

18 (10-122)

9 (1-62)

0.3991

HBeAb positive(%)

10

12

0.8953

HBeAb(mean)(IQR)

23 (0-75)

61 (0-82)

0.7086

VZV IgM(mean)(95%CI)

0.4 (0.3-0.5)

0.4 (0.3-0.4)

0.7237

VZV IgG(mean)(95%CI)

22.5 (11.0-34.1)

22.6 (16.3-28.9)

0.8589

EB VCA IgM(mean)(95%CI)

2.0 (0.3-3.1)

1.5 (0.5-2.5)

0.4881

EB VCA IgG(mean)(95%CI)

8.2 (6.3-10.1)

7.1 (5.7-8.5)

0.3054

EBNA(mean)(95%CI)

3.7 (3.3-4.1)

3.1 (2.6-3.6)

0.2724

CMV IgM(mean)(95%CI)

0.6 (0.3-1.2)

0.5 (0.4-0.6)

0.6208

CMV IgG(mean)(95%CI)

33.3 (18.5-48.1)

32.2(22.6-41.8)

0.8737

Table 2 Comparison of patient characteristics with or without HBV reactivation

 

Reactivation (+)

Reactivation (-)

p

n

3

14

 

female(%)

33

79

0.1186

age(median)(IQR)

64 (53-76)

65 (63-67)

0.8997

disease duration(month)(mean)(95%CI)

237 (101-373)

160 (102-218)

0.1306

duration of administration of TOF(month)(mean)(95%CI)

18.7 (3.5-33.8)

13.5 (5.3-21.8)

0.6106

IgMRF positive(%)

100

79

0.3770

CCP positive(%)

100

79

0.3770

SDAI(Base)(median)(IQR)

11.9 (-28.9-52.6)

14.4 (8.4-20.4)

0.2659

HAQ-DI(mean)(IQR)

0.8 (0.0-1.0)

0.6 (0.2-0.9)

0.4670

TOF dose(mg/day)(mean)(95%CI)

8.3 (1.2-15.5)

8.2 (6.8-9.7)

0.9394

PSL use(%)

0

14

0.4858

PSL dose(mg/day)(mean)(95%CI)

 

3.0 (-9.7-15.7)

 

MTX use(%)

33

21

0.6594

MTX dose(mg/wk)(mean)(IQR)

5.0

8.8 (4.8-12.7)

0.2207

CRP(mg/dL)(Last)(mean)(95%CI)

2.2 (-6.8-11.1)

1.8 (0.3-2.4)

0.8008

MMP-3(mean)(95%CI)

166 (-356-688)

230 (92-368)

0.5287

IgG(mean)(95%CI)

1634 (1391-1876)

1402 (1183-1623)

0.0628

sIL-2R(U/mL)(mean)(95%CI)

558 (278-838)

694 (424-962)

0.8997

WBC(/mm3)(mean)(95%CI)

5373 (3790-6956)

5935 (4440-7431)

1.0000

Lymphocyte(/mm3)(mean)(95%CI)

1358 (-458-3175)

1257 (1047-1467)

0.8997

HBV positive(%)

100

100

 

HBsAb positive(%)

33

43

0.7610

HBsAb(median)(IQR)

2 (0.2-29.6)

17 (8.8-114.5)

0.2207

HBcAb positive(%)

100

50

0.1103

HBcAb(median)(IQR)

9 (7.9-9.8)

8 (4.6-9.8)

0.6831

HBeAb positive(%)

67

14

0.0523

HBeAb(mean)(IQR)

81 (50-86)

12 (0-68)

0.0946

VZV IgM(mean)(95%CI)

0.4 (0.0-0.8)

0.4 (0.3-0.4)

0.5703

VZV IgG(mean)(95%CI)

28.1 (7.1-49.0)

24.0 (15.2-32.9)

0.4497

EB VCA IgM(mean)(95%CI)

2.7 (-3.1-8.4)

2.0 (0.1-3.8)

0.2776

EB VCA IgG(mean)(95%CI)

7.1 (-3.4-17.5)

8.3 (6.9-9.6)

0.8997

EBNA (mean)(95%CI)

3.6 (1.2-6.0)

3.4 (2.9-3.9)

0.8994

CMV IgM(mean)(95%CI)

1.1 (-1.7-3.9)

0.6 (0.5-0.8)

1.0000

CMV IgG(mean)(95%CI)

68.8 (-14.6-152.2)

34.2 (22.6-45.6)

0.0438

 

Disclosure: Y. Urata, None;

To cite this abstract in AMA style:

Urata Y. Virus Reactivation Rate in Rheumatoid Arthritis Using Tofacitinib [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/virus-reactivation-rate-in-rheumatoid-arthritis-using-tofacitinib/. Accessed .

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