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Risk factors for losing hepatitis B virus surface antibody in patients with HBV surface antigen negative/surface antibody positive serostatus receiving biologic disease-modifying anti-rheumatic drugs: a nested case-control study
Hung, Ming-Hui; Tien, Ya-Chih; Chiu, Ying-Ming.
  • Hung, Ming-Hui; Changhua Christian Hospital. Department of Internal Medicine. Division of Allergy, Immunology and Rheumatology. Changhua City. TW
  • Tien, Ya-Chih; Changhua Christian Hospital. Department of Internal Medicine. Division of Allergy, Immunology and Rheumatology. Changhua City. TW
  • Chiu, Ying-Ming; Tungs Taichung MetroHarbor Hospital. Department of Allergy, Immunology, and Rheumatology. Taichung City. TW
Adv Rheumatol ; 61: 22, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1248667
ABSTRACT
Abstract

Background:

Hepatitis B virus (HBV) reactivation consequent to immunosuppressive therapy is an increasingly prevalent problem with serious clinical implications. Treatment with biologic agents conduces to the loss of protective antibody to HBV surface antigen (anti-HBs), which significantly increases the risk of HBV reactivation. Hence, we investigated the risk factors for losing anti-HBs in patients with rheumatic diseases and HBV surface antigen negative/anti-HBs positive (HBsAg-/anti-HBs+) serostatus during treatment with biologic disease-modifying anti-rheumatic drugs (DMARDs).

Methods:

Using a nested case-control design, we prospectively enrolled patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis/psoriasis, or juvenile idiopathic arthritis, who were treated with biologic DMARDs at Changhua Christian Hospital, Taiwan, from January 2013 to June 2019 and had HBsAg-/anti-HBs+ serostatus; the analytic sample excluded all patients with HBsAg+ or anti-HBs- serostatus. Anti-HBs titers were monitored 6-monthly and cases were defined as anti-HBs < 10 mIU/ml during follow-up. Cases were matched one- to-all with controls with anti-HBs ≥ 10 mIU/ml on the same ascertainment date and equivalent durations of biologic DMARDs treatment (control patients could be resampled and could also become cases during follow-up). Between-group characteristics were compared and risk factors for anti-HBs loss were investigated by conditional logistic regression analyses.

Results:

Among 294 eligible patients, 23 cases were matched with 311 controls. The incidence of anti-HBs loss was ∼ 2.7%/person-year during biologic DMARDs treatment. Besides lower baseline anti-HBs titer (risk ratio 0.93, 95% CI 0.89-0.97), cases were significantly more likely than controls to have diabetes mellitus (risk ratio 4.76, 95% CI 1.48-15.30) and chronic kidney disease (risk ratio 14.00, 95% CI 2.22-88.23) in univariate analysis. Risk factors remaining significantly associated with anti-HBs loss in multivariate analysis were lower baseline anti-HBs titer (adjusted risk ratio 0.93, 95% CI 0.88-0.97) and chronic kidney disease (adjusted risk ratio 45.68, 95% CI 2.39-871.5).

Conclusions:

Besides lower baseline anti-HBs titer, chronic kidney disease also strongly predicts future anti-HBs negativity in patients with HBsAg-/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases. Patients with low anti-HBs titer (≤ 100 mIU/ml) and/or chronic kidney disease should be monitored during biologic DMARDs therapy, to enable timely prophylaxis to preempt potential HBV reactivation.
Assuntos


Texto completo: DisponíveL Índice: LILACS (Américas) Assunto principal: Produtos Biológicos / Vírus da Hepatite B / Doenças Reumáticas / Antirreumáticos / Antígenos de Superfície da Hepatite B Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo prognóstico / Fatores de risco Limite: Humanos Idioma: Inglês Revista: Adv Rheumatol Assunto da revista: Artrite / Reumatologia Ano de publicação: 2021 Tipo de documento: Artigo País de afiliação: Taiwan Instituição/País de afiliação: Changhua Christian Hospital/TW / Tungs Taichung MetroHarbor Hospital/TW

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Texto completo: DisponíveL Índice: LILACS (Américas) Assunto principal: Produtos Biológicos / Vírus da Hepatite B / Doenças Reumáticas / Antirreumáticos / Antígenos de Superfície da Hepatite B Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo prognóstico / Fatores de risco Limite: Humanos Idioma: Inglês Revista: Adv Rheumatol Assunto da revista: Artrite / Reumatologia Ano de publicação: 2021 Tipo de documento: Artigo País de afiliação: Taiwan Instituição/País de afiliação: Changhua Christian Hospital/TW / Tungs Taichung MetroHarbor Hospital/TW