Background The risk of the hepatitis B virus (HBV) reactivation in patients who received immunosuprressive agents was pointed out these days. The frequency of the patients over 50 years old with resolver hepatitis B virus in our country is 20–32%, and it is difficult in medical economics to carry out preventional medication of nucleic acid analog to all the patients. The guidline against HBV developed by immunosuppression, chemotherapy (2013) was published by the Japan society of hepatology, which says that if anti-HBs or anti-HBc is positive, HBV-DNA and ALT/AST should be observed every one-three mouths, and the dosage of the nucleic acid analog is recommended if HBV-DNA is more than 2.1log copies/mL. HBV-DNA monitoring situation in our department was examined this time.
Methods In our department, 213 patients are treated for rheumatoid arthritis (RA) between April 2012 and October 2014 who fulfilled the 2010 ACR/EULAR criteria for RA. All patients were evaluated for HBV markers, including HBsAg, antihepatitis B surface antibody (anti-HBs), and antihepatitis B core antibody (anti-HBc). 3 patients (1.4%) were excluded by HBsAg-positive. We prospectively investigated the reactivation rate and appearance for HBV-DNA replication in cases of RA with resolved hepatitis B and evaluated the monitoring period of HBV-DNA levels. HBV-DNA was measured every 1-3 months in patients based on HBsAg-negative and anti-HBs-positive or/and anti-HBc-positive at baseline.
Results 60 patients (33.3%) were either anti-HBsAb-positive or anti- HBcAb-positive at baseline. The rate in another age of RA patients with resolved hepatitis B were 6/35 (17.1%) under 49, 5/22 (22.7%) at 50s, 17/74 (23.0%) at 60s, 32/79 (40.5%) over 70. We enrolled 34 patients (11 males and 23 females) who had anti-HBs-possitive or anti-HBc positive and who had received immunosuppressive drugs and Biological disease-modifying antirheumatic drugs (DMARDs). The mean age and disease duration were 68.2 years old and 13 years. The number of patients who received methotrexate (MTX) therapy were 30 patients, tacrolimus were 2 patients, mizoribine (MZB) were 2 patients, glucocorticoid were 9 patients. The number of patients who received Biological DMARDs were 8 patients (infliximab: 4, golimumab: 1, abatacept: 1, tocilizumab: 1 and certolizumab pegol: 1). In the first-time inspection, HBV-DNA had not detected in all patients. The average monitoring interval was every 6.7 weeks. The average monitoring period was 15.6 months. Although very-small-quantity of HBV-DNA (<2.1 log copies/mL) was observed twice in one patient received MTX, MZB and infliximab. After entecavir treatment started, HBV-DNA was undetected promptly, and re-detectation was not observed and did not increase the level of AST and ALT, either. We could not observe any reactivation of HBV-DNA levels in other patients.
Conclusions We experienced one patient who developed reactivation of HBV-DNA during HBV-DNA monitoring. We have to recognize that the risk of HBV revitalization was high in patients who received immunosuppressant agents and biological DMARDs. Therefore it was important to monitor HBV-DNA levels every a few months in RA patients with resolved hepatitis B virus.
Disclosure of Interest None declared