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Risk of Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Undergoing Tocilizumab-Containing Treatment.
Kuo, Meng Hsuan; Tseng, Chih-Wei; Lu, Ming-Chi; Tung, Chien-Hsueh; Tseng, Kuo-Chih; Huang, Kuang-Yung; Lee, Chi-Hui; Lai, Ning-Sheng.
  • Kuo MH; Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
  • Tseng CW; School of Medicine, Tzuchi University, Hualien, Taiwan. cwtseng2@gmail.com.
  • Lu MC; Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chia-Yi County, 62247, Taiwan. cwtseng2@gmail.com.
  • Tung CH; School of Medicine, Tzuchi University, Hualien, Taiwan.
  • Tseng KC; Division of Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
  • Huang KY; School of Medicine, Tzuchi University, Hualien, Taiwan.
  • Lee CH; Division of Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
  • Lai NS; School of Medicine, Tzuchi University, Hualien, Taiwan.
Dig Dis Sci ; 66(11): 4026-4034, 2021 11.
Article in English | MEDLINE | ID: covidwho-1002116
ABSTRACT
BACKGROUND AND

AIM:

To investigate the risk of hepatitis B virus reactivation in patients undergoing long-term tocilizumab therapy for rheumatoid arthritis.

METHOD:

From January 2011 through August 2019, a total of 97 patients were enrolled in this retrospective study. Clinical data, comedications, and the occurrence of HBV reactivation were recorded.

RESULTS:

Seven patients were HBsAg+ (7.2%), 64 were HBsAg-/HBcAb+ (65.9%), and 26 were HBsAg-/HBcAb- (26.8%). The median disease follow-up time was 9 years. TCZ was administered for a median of 29 months. Four patients (4.1%) experienced HBV reactivation after tocilizumab therapy. Of the 7 HBsAg+ patients, 4 received antiviral prophylaxis and had no HBV reactivation; the remaining 3 patients did not receive antiviral prophylaxis, and all 3 (100%) experienced HBV reactivation and hepatitis flare-up. Hyperbilirubinemia occurred in 2 of these 3 patients, with mild prothrombin time prolongation in one. After salvage entecavir treatment, all patients had a favorable outcome. Of the 64 HBsAg-/HBcAb+ patients, only one became positive for serum HBV DNA (2.5 × 107 IU/mL) after 18 months of tocilizumab treatment (1.6%; 1/64). This patient was immediately treated with entecavir, which prevented hepatitis flare-up.

CONCLUSIONS:

Tocilizumab is widely used in treating rheumatoid arthritis and has the potential to reduce the mortality rate among severe COVID-19 patients. However, HBV reactivation needs to be considered. HBsAg+ patients have a high risk of HBV reactivation, which could be prevented by antiviral prophylaxis. Although the risk of reactivation is low in HBsAg-/HBcAb+ patients, strict monitoring is necessary.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Virus Activation / Antirheumatic Agents / Hepatitis B, Chronic / Antibodies, Monoclonal, Humanized Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Dig Dis Sci Year: 2021 Document Type: Article Affiliation country: S10620-020-06725-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Virus Activation / Antirheumatic Agents / Hepatitis B, Chronic / Antibodies, Monoclonal, Humanized Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: Dig Dis Sci Year: 2021 Document Type: Article Affiliation country: S10620-020-06725-1