In patients with inflammatory arthritis receiving disease-modifying antirheumatic drugs (DMARDs), rates of hepatitis B (HBV) reactivation differ between those whose disease is resolved and those with chronic HBV infection. Findings from the systematic review and meta-analysis were published in Arthritis Care & Research (Hoboken).
Patients with chronic HBV generally have a 5-fold to 8-fold higher risk for HBV reactivation than those with resolved HBV. Evidence over the past 2 decades has suggested that HBV reactivation is associated with the use of tumor necrosis factor (TNF) biologic DMARDs in patients with such inflammatory disorders as rheumatoid arthritis and psoriatic arthritis. Additional reports have demonstrated HBV reactivation among those treated with such non-TNF DMARDs as abatacept and tocilizumab.
When counseling patients on their individual risks, identification of HBV reactivation rates associated with various DMARD regimens, along with the addition of antiviral prophylaxis, is critical.
A systematic review and meta-analysis was conducted to evaluate the risk for HBV reactivation among patients with inflammatory arthritis receiving DMARD therapy.
The objectives of the current study were to (1) examine HBV reactivation rates among patients with inflammatory arthritis who had resolved or chronic HBV infection and who did not receive antiviral prophylaxis, including subgroup analysis according to DMARD type and (2) evaluate HBV reactivation rates in patients with inflammatory arthritis and chronic HBV who did receive antiviral therapy. The primary outcome of the study was HBV reactivation following DMARD initiation. A total of 25 studies were included in the final analysis. None of the studies included patients using antiviral prophylaxis who had resolved HBV. Overall, 1032 participants with resolved HBV and 259 with chronic HBV were included in the meta-analysis.
Among all people with inflammatory arthritis and resolved HBV receiving any type of DMARD and no antiviral prophylaxis, the HBV reactivation rate was low (1.6%). In contrast, the reactivation rate was considerably higher (14.6%) among those with chronic HBV infection who did not receive antiviral treatment. HBV reactivation rates were lower among all patients with chronic HBV infection taking antiviral prophylaxis, regardless of whether they were receiving TNF inhibitors.
The investigators concluded that future larger prospective studies with detailed antiviral exposure records and adjustments for HBV severity are warranted to define the effectiveness of antiviral agents in people with rheumatology.
Dr Solomon receives research support through the NIH K24, AR – 099589.
Dr Solomon’s potential conflicts include research support to his institution for unrelated projects from Amgen, Astra Zeneca, Bristol-Myers Squibb, Eli Lily, Pfizer, and Genentech.
Lin TC, Yoshida K, Tedeschi SK, de Abreu MM, Hashemi N, Solomon DH. Risk of hepatitis B reactivation in inflammatory arthritis patients receiving disease modifying anti-rheumatic drugs (DMARDs): a systematic review and meta-analysis [published online August 22, 2017]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23346