Background The rate of viral reactivation in occult HBV carriers (HBsAg-/HBcAb+) in the course of immunosuppressive therapy ranges from 5% to 10%.(1) Nevertheless, anti-TNFalpha therapy was reported to be quite a safe option in HBV occult carriers (i.e. HBsAg-; HBcAb+) patients in Italy(2). Recent data from Taiwan (Cina) pointed out the occurrence of viral reactivation in 1/12 HBV occult carriers patients with Rheumatoid Arthritis (RA) undergoing such treatment(3).
Objectives This abstract is devoted to furtherly address this topic.
Methods Three hundred and three patients(164F, aged 52,4±12,8) with RA or Spondylarthritis (SA) observed from May 2002 to July 2011, were administered anti-TNFalfa treatment for 42±30,5 months. Serological screening for HBV infection with hepatitis B surface antigen (HBsAg), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antibody (anti-HBs) was performed in all patients. Moreover, Aminotransferases (ALT, AST) were evaluated at baseline and every 4 weeks. Finally, HBV-DNA evaluation was planned in HBcAb+ HBsAb+/- patients if transaminases would have increased >2 upper normal value in two consecutive determinations.
Results Fifty out of the 303 patients investigated, (25F, aged 58,1±11,2) (16,5%) were HBsAg-/HBcAb +. Out of them 37 were HBsAb + (74%);10 HBsAb- (20%);in 3 patients HBsAb was not available. Ten patients were treated with IFX, 19 with ETA, 17 with ADA and 4 with GOL for 44,5±28,3 months. Twelve patients were also treated with Methotrexate (MTX), 4 with Leflunomide (LFN) and 11 with Prednisone (PDN) (<7.5mg/day). None of them underwent antiviral prophylaxis. Five patients developed an increase in ALTx 2 normal value in 2 consecutive determinations: 4 were HBsAb+ and 1 was HBsAb-.HBsAg positivity and HBV-DNA were not detected in any of them. ALT value reverted to normal in all patients by reducing or discontinuing MTX temporarily.
Conclusions Our results support the safety of long term anti-TNFalpha treatment in patients with inflammatory arthritis and HBV occult infection whichever is the HBsAb status.
Charpin C. et al. Safety of TNF-blocking agents in rheumatic patients with serology suggesting past epatiti B state:results from a color of 21 patients. Arthritis Res Ther 2009,11:R179.
Caporali R et al. Safety of tumor necrosis factor α blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/anti-hepatitis B core antigen positive) with rheumatic diseases. Arthritis Care Res. 2010, 749-754.
Joung-Liang Lan et al. Kinetics of viral loads and risk of Hepatitis B virus reactivation in Hepatitis B core antibody-positive rheumatoid arthritis patients undergoing anti tumor necrosis factor alpha therapy.Ann Rheu Dims 2011;70:1719-1725.
Disclosure of Interest None Declared
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