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.
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.
Disclosure of Interest None declared