Dr. Cacoub has received consultant fees, speaking fees, and/or honoraria (more than $10,000 each) from MSD, Servier, and Vifor Pharma.
Kinetic Profiles and Management of Hepatitis B Virus Reactivation in Patients With Immune-Mediated Inflammatory Diseases
Version of Record online: 26 AUG 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 9, pages 1504–1514, September 2013
How to Cite
Droz, N., Gilardin, L., Cacoub, P., Berenbaum, F., Wendling, D., Godeau, B., Piette, A.-M., Dernis, E., Ebbo, M., Fautrel, B., Le Guenno, G., Mekinian, A., Bernard-Chabert, B., Costedoat-Chalumeau, N., Descloux, E., Michot, J.-M., Radenne, S., Rigolet, A., Rivière, S., Yvin, J.-L., Thibault, V., Thabut, D., Pol, S., Guillevin, L., Mouthon, L. and Terrier, B. (2013), Kinetic Profiles and Management of Hepatitis B Virus Reactivation in Patients With Immune-Mediated Inflammatory Diseases. Arthritis Care Res, 65: 1504–1514. doi: 10.1002/acr.21990
- Issue online: 26 AUG 2013
- Version of Record online: 26 AUG 2013
- Accepted manuscript online: 22 FEB 2013 10:51AM EST
- Manuscript Accepted: 13 FEB 2013
- Manuscript Received: 15 OCT 2012
Immunosuppressive therapy may trigger hepatitis B virus (HBV) reactivation for increased morbidity and mortality. We aimed to describe HBV reactivation in patients receiving treatment for immune-mediated inflammatory diseases (IMIDs) and to evaluate a predefined algorithm for its prevention.
Physicians submitted data for patients receiving treatment for IMIDs and exhibiting HBV reactivation, defined as an increase of >1 log10 IU/ml of HBV DNA levels or DNA reappearance. We systematically reviewed cases in the literature.
The 35 physician-collected patients had rheumatoid arthritis (n = 14), connective tissue disease (n = 7), vasculitis (n = 5), and other diseases (n = 9). At baseline, 65.7% of patients were positive for hepatitis B surface antigen (HBsAg), 31.4% had a history of HBV infection, and 2.9% had occult HBV infection. Reactivation occurred a median of 35 weeks (range 2–397 weeks) after the start of corticosteroid and/or immunosuppressive therapy. In all, 88.6% of patients were clinically asymptomatic, but 25.7% had severe hepatitis; none had fulminant hepatitis. Management was antiviral therapy for 91.4%, with discontinuation or decrease of immunosuppressive therapy for 45.7%. In pooling these 35 cases and 103 patients from the literature, 73.9% of patients were clinically asymptomatic, 33.3% had severe hepatitis, and 12.3% died and/or had fulminant hepatitis. Reactivation occurred early with rituximab or cyclophosphamide therapy and in HBsAg-positive/HBV DNA–positive patients. Using the predefined algorithm, 78% of patients with reactivation would have received preemptive antiviral therapy.
We provide new insights into HBV reactivation in patients receiving treatment for IMIDs. A predefined algorithm may be effective in reducing the risk of HBV reactivation in this population.