Background Turkish Society of Rheumatology (TSR) proposed a guideline of recommendations for viral hepatitis screening before biological therapy in 2015.¹

Objectives The aim of this study was to assess results of viral hepatitis serological tests performed before biologics in RA patients.

Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective,single center database of biological treatments including 1229 RA patients by August 2016. Results of serological tests for HBV of 468 RA patients were evaluated. The guideline includes 5 groups according to hepatitis B virus (HBV) serology; group 1 –HBV seronegative [HbsAg (-),anti HbS (-), anti-Hbc total (-)], group 2-vaccinated [HBsAg (-), anti-HBs (+), anti-HBc total (-)], group 3-previous HBV infection [HBsAg (-), anti-HBs (-), anti-HBc total (+)], group 4- Chronic HBV infection [HBsAg (+), anti-HBs (-), anti-HBc total (+)], group 5- secondary immunity [HBsAg (-), anti-HBs (+), anti-HBc total (+)]. Patients were also classified according to risk for HBV reactivation as very high risk (Group 4 patients receiving rituximab), high risk (group 3 patients receiving rituximab) and medium risk (Group3 or Group 4 patients receiving TNFi or T-cell blockers,IL12/23 pathway inhibitor). Screening results for hepatitis C virus (HCV) were also evaluated.

Results Among 1229 patients (79.7% female), mean age was 54.9±11.7 and mean disease duration was 12.3±8.2 years. In total, 104 (22.2%) of patients had received rituximab. Serology for HbsAg, anti-Hbs and anti-HbC were avaliable in 468 patients. There were 273 (58.3%) patients in group 1, 81 (17.3%) in group 2, 19 (4.1%) in group 3, 9 (1.9%) in group 4 and 86 (18.3%) in group 5. Table 1 represents distribution of patients according to HBV reactivation risk. Anti-HCV was positive in 21 (2.5%) of patients.

Conclusions Among patients registered in HUR-BIO, 1.9% had chronic HBV infection and 2.5% anti-HCV positivity. 5.0% of them were under high and/or very high risk for HBV reactivation. Medium risk group which includes 17.0% of patients, seems to deserve most of the attention. Screening for viral hepatitis must be performed before biologics and TSR guideline may be useful in this matter.

References

1. Karadag O, Kasifoglu T et al. Guideline of the viral hepatitis screening before biologic agents use in patients with rheumatic diseases. RAED Journal;7:28–32.

References

Disclosure of Interest None declared