Use of biological disease-modifying anti-rheumatic drugs in patients with concurrent rheumatic disease and hepatitis B
Article first published online: 23 MAY 2012
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 5, pages 523–531, May 2012
How to Cite
King, L. K., Lee, A. and Anandacoomarasamy, A. (2012), Use of biological disease-modifying anti-rheumatic drugs in patients with concurrent rheumatic disease and hepatitis B. Internal Medicine Journal, 42: 523–531. doi: 10.1111/j.1445-5994.2011.02569.x
Conflict of interest: None.
- Issue published online: 23 MAY 2012
- Article first published online: 23 MAY 2012
- Accepted manuscript online: 25 JUL 2011 05:47AM EST
- Received 7 November 2010; accepted 21 June 2011.
- rheumatoid arthritis;
- hepatitis B virus;
- biological therapy;
- virus activation
Background: Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in the management of inflammatory arthritides. Reactivation of hepatitis B virus (HBV) is a potential adverse outcome in patients treated with bDMARDs. There is currently no consensus on the approach to identifying and treating these patients with underlying HBV infection.
Aim: The aims of this study were to assess the risk of HBV reactivation in patients treated with bDMARDs, and to determine whether HBV screening should be carried out in all patients prior to commencing bDMARDs.
Methods: A literature search was undertaken to identify all reports of patients with inflammatory arthritides and concurrent HBV infection being treated with bDMARDs.
Results: Forty-three patients with HBV infection were identified, of whom eight patients developed HBV reactivation after exposure to bDMARDs. Of the patients who experienced reactivation, two had unknown infection that surfaced during bDMARD therapy. Patients who experienced reactivation were promptly treated with antiviral therapy and saw clinical improvement. There are no long-term data on these patients.
Conclusions: HBV reactivation may result in serious consequences, including death. Tuberculosis screening prior to bDMARD treatment is already standard practice, as is HBV screening for patients undergoing cancer chemotherapy. Implementing HBV screening for all patients prior to bDMARD treatment can identify patients with chronic HBV who may require antiviral therapy.