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Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib: a real-world study
  1. Yi-Ming Chen1,2,3,4,
  2. Wen-Nan Huang1,2,
  3. Yi-Da Wu1,
  4. Ching-Tsai Lin1,
  5. Yi-Hsing Chen1,2,
  6. Der-Yuan Chen1,2,3,4,5,
  7. Tsu-Yi Hsieh1,6
  1. 1Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
  4. 4Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
  5. 5Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
  6. 6Ph D Program of Business, College of Business, Feng Chia University, Taichung, Taiwan
  1. Correspondence to Dr Tsu-Yi Hsieh, Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan; zuyihsieh{at}gmail.com

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A recent study reported long-term safety outcomes of tofacitinib for rheumatoid arthritis (RA) in global clinical trials1; the safety profile of tofacitinib exposure through 8.5 years appeared stable over time, with no new detectable safety signals. However, since most tofacitinib studies excluded patients with chronic hepatitis B (HBV) infection,1 2 the risk of HBV reactivation among tofacitinib-treated patients remains unknown.

More than two billion people globally have been infected by HBV,3 and a substantial number of patients with RA outside North America and Western Europe have coexisting HBV infection.4 HBV reactivation is a critical challenge in patients with RA receiving biological therapy5; consequently, HBV screening is recommended before initiating biologics.3 Janus kinase inhibition may counteract the suppressive effects of interferon α on viral replication6; therefore, we assessed the risk of HBV reactivation in patients receiving tofacitinib.

We established a retrospective cohort of 116 Taiwanese patients with RA who received tofacitinib at a single medical centre between April 2015 …

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