Risk stratification and clinical course of hepatitis B virus reactivation in rheumatoid arthritis patients with resolved infection: final report of a multicenter prospective observational study at Japanese Red Cross Hospital

Fukuda, Wataru; Hanyu, Takaaki; Katayama, Masaki; Mizuki, Shinichi; Okada, Akitomo; Miyata, Masayuki; Handa, Yuichi; Hayashi, Masatoshi; Koyama, Yoshinobu; Arii, Kaoru; Kitaori, Toshiyuki; Hagiyama, Hiroyuki; Urushidani, Yoshinori; Yamasaki, Takahito; Ikeno, Yoshihiko; Suzuki, Takeshi; Omoto, Atsushi; Sugitani, Toshifumi; Morita, Satoshi; Inokuma, Shigeko

doi:10.1186/s13075-019-2053-1

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…A recent prospective multicenter study on the evaluation of HBV reactivation during treatment with antirheumatic drugs and other immunotherapeutic drugs has been reported ( 23 , 24 ). This is truly the first prospective evaluation of HBV reactivation in all patients receiving immunosuppressive chemotherapy at a single institution.…”

Section: Discussionmentioning

confidence: 99%

Efficient Prophylactic Management of HBV Reactivation by an Information Technology Encoding System: Results of a 6-year Prospective Cohort Study

et al. 2020

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Objective We started an information technology (IT) system that encodes the medical treatment status of hepatitis B virrus (HBV) with a 9-digit number, automatically checks for inappropriate situations occurring due to immunosuppression and chemotherapy that do not comply with the flowchart of the hepatitis B countermeasure guideline, and promotes correct HBV medical treatment in our hospital. We conducted a prospective study of HBV reactivation using this system. Methods Among 21,607 cases that were managed using this system, 1,206 patients who were HBs antigen-negative, HBc antibody- and/or HBs antibody-positive and in whom HBV DNA quantification was performed two times or more were examined for the occurrence of HBV reactivation. The study population included: malignant lymphoma patients using rituximab (n=40), patients with malignant tumors using anticancer agents (n=546), patients treated with steroids (n=274), rheumatoid arthritis (RA) patients (n=144), patients using immunosuppressants/biologics (n=26), and patients undergoing hepatitis C direct acting antiviral (DAA) treatment (n=176). Results HBV reactivation was observed in 27 cases undergoing treatment with the following agents: rituximab (n=6), anticancer agents (n=8), steroids (n=10), anti-RA agents (n=1), and hepatitis C DAA (n=2). Among the 40 patients who were using rituximab, 6 (18.2%) showed a high rate of reactivation. In 10 in which HBV reactivation occurred at a median of 10 (range, 4-32) months after steroid administration, 6 occurred after the 7th month, and 1 patient showed HBs antigen positivity and severe hepatitis. Conclusion Continuing of the operation of an automatic check system using coded medical information to check for the reactivation enabled this prospective study of HBV reactivation. Careful attention should be paid to patients using steroids, as well as malignant lymphoma patients who are treated with rituximab. The results of the present study suggest that the present IT encoding system would be useful for preventing HBV reactivation.

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Section: Discussionmentioning

confidence: 99%

Efficient Prophylactic Management of HBV Reactivation by an Information Technology Encoding System: Results of a 6-year Prospective Cohort Study

et al. 2020

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“…The incidence of HBV reactivation has been reported to range from 1.5% to 5% (Tamori et al 2011;Fujita et al 2018;Matsuzaki et al 2018;Fukuda et al 2019;Watanabe et al 2019), and some studies also included patients who developed de novo hepatitis B (Matsuzaki et al 2018). Although we cannot directly compare the incidence because the observation periods were different between studies, the incidence of HBV reactivation in our hospital was considered comparable to previous reports; however, no case developed de novo hepatitis B.…”

Section: Discussionmentioning

confidence: 99%

“…Essentially, all types of bDMARDs and tsDMARDs have a risk of HBV reactivation (Fukuda et al 2019;Watanabe et al 2019). It is also well known that drugs such as MTX, PSL, and tacrolimus can cause HBV reactivation (Duhart et al 2003;Watanabe et al 2012;Chen et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Approach to Prevent <i>de novo</i> Hepatitis B in Patients with Rheumatoid Arthritis

Watanabe

Igarashi

Takahashi

et al. 2020

Tohoku J. Exp. Med.

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The reactivation of hepatitis B virus (HBV) in patients with rheumatoid arthritis (RA) is currently a social problem. Our hospital has established a project team, which consisted of medical staff including doctors, nurses, pharmacists, and technicians, to prevent HBV reactivation and subsequent de novo hepatitis B in 2015. To verify the usefulness of the team, we aimed to examine the implementation rate of HBV screening tests in patients with RA in 2011RA in , 2015RA in , and 2018. We also examined the rate of HBV infection, as well as the rate of HBV reactivation during the course. In this study, medical records of patients who visited our hospital in 2011, 2015, and 2018 were retrospectively reviewed. HBV screening was completed when hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) were all examined. The prevalence of patients who completed HBV screening dramatically increased from 2.4% in 2011 to 79.1% in 2015 and 86.9% in 2018. Patients who completed the screening had significantly higher rates of liver dysfunction, methotrexate use, and use of biological disease-modifying antirheumatic drugs than those who did not. Of the 767 patients who completed HBV screening in 2018, 157 patients (20.5%) had previously resolved HBV infection (HBsAg-negative but HBsAb-and/or HBcAbpositive). During a mean follow-up of 41.0 months, reactivation of HBV was observed in 10 out of the 157 patients (6.4%); however, none developed de novo hepatitis B. In conclusion, our multidisciplinary approach to prevent de novo hepatitis B is considered useful.

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“…According to Harigai et al [22], another study evaluated the risk of HBV reactivation in RA patients with negative HBsAg and anti-HBs positivity and/or anti-HBc positivity treated with corticosteroids (≥5 mg prednisolone or its equivalent dose), DMARDs and/or bDMARDs, [12]. Considering the following scoring system-HBV reactivation risk score = 1 × (age >70 years) + 2 × (HBcAb positivity alone) + 1 × (treatment other than methotrexate monotherapy)-the authors found that patients with the highest score had an odds ratio of 13.01 for HBV reactivation, compared to those with the lowest score.…”

Section: Occult Hbv Infection In Patients Treated With Rheumatologic Drugsmentioning

confidence: 99%

“…Several lines of evidence [12,13] showed that the screening of HBV infection in rheumatologic patients who needed immunosuppressive therapy reduces the risk of HBV clinical consequences such as reactivation in OBI patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment or Prophylaxis against Hepatitis B Virus Infection in Patients with Rheumatic Disease Undergoing Immunosuppressive Therapy: An Update

Stasi

Tiengo

Sadalla

et al. 2021

JCM

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Chronic hepatitis B virus (HBV) flares or reactivations are serious causes of morbidity or mortality in rheumatologic patients undergoing immunosuppressive therapy. The recent insights in the pathogenesis of rheumatic diseases led to the use of new immunosuppressive therapies indicated in case of failure, partial response, or intolerance of conventional synthetic disease-modifying anti-rheumatic drugs. Based on these premises, this review examines and discusses the main rheumatologic treatments that could require the initiation of prophylactic treatment or close monitoring of occult HBV infection in patients beginning antiviral therapy at the first signs of HBV reactivation, or antiviral treatment in chronic HBV-infected patients. We searched for relevant studies published in the last five years. Studies suggested that the presence of HBV infection is common in rheumatic patients and HBV reactivation during these immunosuppressant treatments is quite frequent in these kinds of patients. Therefore, before starting an immunosuppressive therapy, patients should be screened for HBsAg, anti-HBs, and anti-HBc and, on the basis of markers positivity, they should be carefully characterized for HBV infection phases. In conclusion, screening of HBV infection in patients undergoing immunosuppressive therapy with subsequent HBV monitoring, prophylaxis or treatment consistently reduces the risk of clinical consequences.

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Risk stratification and clinical course of hepatitis B virus reactivation in rheumatoid arthritis patients with resolved infection: final report of a multicenter prospective observational study at Japanese Red Cross Hospital

Cited by 17 publications

References 18 publications

Efficient Prophylactic Management of HBV Reactivation by an Information Technology Encoding System: Results of a 6-year Prospective Cohort Study

Efficient Prophylactic Management of HBV Reactivation by an Information Technology Encoding System: Results of a 6-year Prospective Cohort Study

Multidisciplinary Approach to Prevent <i>de novo</i> Hepatitis B in Patients with Rheumatoid Arthritis

Treatment or Prophylaxis against Hepatitis B Virus Infection in Patients with Rheumatic Disease Undergoing Immunosuppressive Therapy: An Update

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