Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib

Wang, Sz-Tsan; Tseng, Chih‐Wei; Hsu, Chia-Wen; Tung, Chien-Hsueh; Huang, Kuang-Yung; Lu, Ming‐Chi; Lai, Ning‐Sheng

doi:10.1111/1756-185x.14217

Cited by 27 publications

(18 citation statements)

References 27 publications

(34 reference statements)

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“…114 115 As outlined in the SLR informing these recommendations, data are less robust for drugs [116][117][118][119][120][121][122][123][124][125] other than bDMARDs. [126][127][128][129][130][131][132][133][134][135][136] However, for non-bDMARDs users, referral to a hepatologist for consideration of anti-viral prophylaxis is also recommended. The exact dose and duration of glucocorticoids that would increase HBV reactivation risk cannot be inferred from existing studies.…”

Section: Recommendationmentioning

confidence: 99%

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

et al. 2022

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ObjectivesTo develop EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).MethodsAn international Task Force (TF) (22 members/15 countries) formulated recommendations, supported by systematic literature review findings. Level of evidence and grade of recommendation were assigned for each recommendation. Level of agreement was provided anonymously by each TF member.ResultsFour overarching principles (OAP) and eight recommendations were developed. The OAPs highlight the need for infections to be discussed with patients and with other medical specialties, in accordance with national regulations. In addition to biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before conventional synthetic DMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) antiviral treatment should be guided by HBV status defined prior to starting antirheumatic drugs. All patients positive for hepatitis-C-RNA should be referred for antiviral treatment. Also, patients who are non-immune to varicella zoster virus should be informed about the availability of postexposure prophylaxis should they have contact with this pathogen. Prophylaxis againstPneumocystis jiroveciiseems to be beneficial in patients treated with daily doses >15–30 mg of prednisolone or equivalent for >2–4 weeks.ConclusionsThese recommendations provide guidance on the screening and prevention of chronic and opportunistic infections. Their adoption in clinical practice is recommended to standardise and optimise care to reduce the burden of opportunistic infections in people living with AIIRD.

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Section: Recommendationmentioning

confidence: 99%

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

et al. 2022

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“…Tofacitinib appears safe in patients with resolved HBV infection ( 26 ) and reactivation of HBV infection could be prevented by antiviral prophylaxis. However, it is important to beware of the high incidence rate of HBV reactivation in patients with HBsAg + receiving tofacitinib and close monitoring of HBV DNA and alanine aminotransferase should be suggested ( 27 ). In clinical trials of tofacitinib for rheumatoid arthritis, no new AEs were observed in 10 years ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

Zhang

Bai-fu

et al. 2022

Front. Med.

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IntroductionAlopecia areata (AA) is an autoimmune hair loss mediated by CD8 + T cells. Treatment for moderate-to-severe AA is still challenging. Janus kinase inhibitors, such as tofacitinib, have been recently investigated as a promising treatment option for AA. Evidence on the combination use of oral tofacitinib and systemic corticosteroids (SCs) for AA is still lacking.ObjectiveTo compare the efficacy and safety of monotherapy of oral tofacitinib and SCs, as well as their combination in patients with moderate-to-severe AA.MethodsPatients with moderate-to-severe AA, who have been treated with at least 3 months of monotherapy of tofacitinib or SCs, or in their combination, were included in this study. The efficacy and adverse events of these treatments were retrospectively analyzed.ResultsSixty-one patients with moderate-to-severe AA were included in this study. There were 12 (66.7%) of 18 patients in the SCs group, 12 (60.0%) of 20 patients in the tofacitinib group, and 18 (78.3%) of 23 patients achieved SALT50, with no significant difference among the three groups. The ratio of patients who achieved SALT50 was significantly higher in patients with a short duration of current hair loss episode (≤2 years) than in those with a duration of current hair loss episode (>2 years) in all the three groups. There were 66.7% patients in the SCs group, 35.0% patients in the tofacitinib group, and 56.5% patients in the combined group that showed adverse effects.ConclusionTofacitinib was an effective treatment for patients with moderate-to-severe AA, and it was more tolerated than SCs. A combination of tofacitinib and SCs may have higher efficacy than SCs alone. Efficacy significantly decreased in patients with a current episode of disease for more than 2 years.

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“…Data on the risk of HBV reactivation during COVID-19 are scarce, but those from other sectors (onco-haematological, rheumatological, gastroenterological) [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] strongly suggest that all patients, including SARS-CoV-2 RNA-positive, should be screened for markers of HBV infection before starting corticosteroid and / or immunosuppressive treatments. HBsAg-positive patients should earlier start prophylaxis anti-HBV reactivation with high genetic barrier antivirals and continue for at least 12 months after stopping these therapies.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 as Another Trigger for HBV Reactivation: Clinical Case and Review of Literature

Sagnelli

Montella²,

Grimaldi³

et al. 2022

Pathogens

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Universal hepatitis B virus (HBV) vaccination has been applied for years in most countries, but HBV infection remains an unresolved public health problem worldwide, with over one-third of the world’s population infected during their lifetime and approximately 248 million hepatitis B surface antigen (HBsAg) chronic carriers. HBV infection may reactivate with symptomatic and sometimes life-threatening clinical manifestations due to a reduction in the immune response of various origins, due to chemotherapy or immunosuppressive therapy, treatments increasingly practiced worldwide. SARS-CoV-2 and its COVID-19 associated disease have introduced new chances for HBV reactivation due to the use of dexamethasone and tocilizumab to counteract the cytokine storm. This could and should be prevented by accurate screening of HBV serologic markers and adequate pharmacologic prophylaxis. This article describes the case of a patient with COVID-19 who developed HBV reactivation and died of liver failure and analyzes published data on this setting to provide useful information to physicians who manage these patients during the SARS-CoV-2 pandemic.

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Reactivation of hepatitis B virus infection in patients with rheumatoid arthritis receiving tofacitinib

Cited by 27 publications

References 27 publications

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

Oral Tofacitinib and Systemic Corticosteroids, Alone or in Combination, in Patients With Moderate-to-Severe Alopecia Areata: A Retrospective Study

COVID-19 as Another Trigger for HBV Reactivation: Clinical Case and Review of Literature

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