Background Hepatitis B surface antigen (HBsAg) reverse seroconversion (RS) can happen in patients with rheumatoid arthritis (RA) with resolved hepatitis B (RHB) undergoing biological disease-modifying antirheumatic drugs (bDMARDs). But the incidence and risk factors need to be delineated.
Methods From 2003 to 2019, 1937 patients with RA with available HBsAg and antibody to hepatitis B virus (HBV) core antigen data were retrospectively reviewed, and 489 patients with RHB undergoing bDMARDs treatment were identified. Factors associated with HBsAg RS were analysed.
Results During 67 828 person-months of follow-up, 27 (5.5%) patients developed HBsAg RS after bDMARD treatment. As compared with those without HBsAg RS, patients with HBsAg RS were older, had lower frequency of antibody to HBsAg (anti-HBs), and lower baseline anti-HBs levels. In multivariate analysis, rituximab, abatacept and baseline negative for anti-HBs were the independent risk factors for HBsAg RS (adjusted HR: 87.76, 95% CI: 11.50 to 669.73, p<0.001; adjusted HR: 60.57, 95% CI: 6.99 to 525.15, p<0.001; adjusted HR: 5.15, 95% CI: 2.21 to 12.02, p<0.001, respectively). The risk of HBsAg RS was inversely related to the level of anti-HBs. Both rituximab and abatacept might result in anti-HBs loss, and abatacept had a cumulative incidence of HBsAg RS of 35.4%–62.5% in patients with low titers or negative of anti-HBs.
Conclusions Not only rituximab, but also abatacept has a high risk of HBV reactivation in patient with RA with RHB. Anti-HBs positivity cannot confer HBV reactivation-free status if the anti-HBs levels are not high enough for patients with RHB on rituximab and abatacept treatment.
- tumour necrosis factor inhibitors
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All data relevant to the study are included in the article or uploaded as supplementary information.
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Handling editor Josef S Smolen
Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. All authors are accountable for all aspects of the work and will ensure questions related to the accuracy or integrity of any part of the work will be appropriately investigated and resolved. Study concept and design was by M-HC (Ming-Han) and Y-HH. Acquisition of data was done by M-HC (Ming-Han), I-CL, M-CH, C-YT and Y-HH. M-HC (Ming-Huang) helped in analysis and interpretation of data. Drafting of manuscript was done by M-HC (Ming-Han) and Y-HH. Critical revision of the article was done by M-CH (Ming-Han). Study supervision was done by C-YT and Y-HH.
Funding This work was supported by Ministry of Science and Technology, Taiwan (grant numbers MOST 106–2314-B-010–027-MY3).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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