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.
Aged
Aged, 80 and over
Antirheumatic Agents
/ therapeutic use
Antiviral Agents
/ therapeutic use
Arthritis, Rheumatoid
/ complications
Female
Hepatitis B
/ complications
Hepatitis B Antibodies
/ analysis
Hepatitis B virus
/ drug effects
Hospitals
Humans
Incidence
Japan
/ epidemiology
Male
Methotrexate
/ therapeutic use
Middle Aged
Prospective Studies
Red Cross
Risk Factors
Virus Activation
/ drug effects
Hepatitis B virus
Nucleic acid analog
Prognosis
Reactivation
Rheumatoid arthritis
Journal
Arthritis research & therapy
ISSN: 1478-6362
Titre abrégé: Arthritis Res Ther
Pays: England
ID NLM: 101154438
Informations de publication
Date de publication:
28 11 2019
28 11 2019
Historique:
received:
15
05
2019
accepted:
08
11
2019
entrez:
30
11
2019
pubmed:
30
11
2019
medline:
1
9
2020
Statut:
epublish
Résumé
The prophylaxis for hepatitis B virus (HBV) reactivation assumes that hepatic injury after reactivation is often rapidly progressive and can evoke fulminant hepatitis. The incidence and prognosis of reactivation in patients with rheumatoid arthritis (RA) may be different from those receiving organ transplantation and cancer chemotherapy. This study aimed to investigate the incidence, risk factors, and clinical course of HBV reactivation and develop a scoring system for risk stratification in RA patients with resolved infection. HBV DNA was measured using real-time polymerase chain reaction, and patient data were collected for 4 years in RA patients with resolved HBV infection who were treated with steroids or synthetic or biologic immunosuppressive drugs. Among 1127 patients, HBV DNA was detected in 57 patients (1.65/100 person-years); none of the reactivated patients exhibited worsening of hepatic function. Multivariate logistical analysis revealed that age > 70 years and HB core antibody (HBcAb) positivity alone were independent risk factors for HBV reactivation. HBV DNA ≥ 2.1 log copies/mL was observed in 15 patients (0.43/100 person-years); seven patients were treated with nucleic acid analogs (NAAs), whereas the remaining eight were observed without treatment. Among reactivated cases, 15 cases changed to HBV DNA-negative status spontaneously, whereas 24 cases remained HBV DNA positive < 2.1 log copies/mL during the observation period. We designed the following scoring system: HBV reactivation risk score = 1 × (age > 70 years) + 2 × (HBcAb positivity alone) + 1 × (treatment other than methotrexate monotherapy). This revealed that patients with the highest score had an odds ratio of 13.01 for HBV reactivation, compared to those with the lowest score. Rapid progression and poor outcomes after HBV reactivation were not frequent in RA patients with resolved infection. Our new risk scoring system might be useful for screening and optimization of prophylactic treatment by distinguishing patients with significantly lower reactivation risk.
Sections du résumé
BACKGROUND
The prophylaxis for hepatitis B virus (HBV) reactivation assumes that hepatic injury after reactivation is often rapidly progressive and can evoke fulminant hepatitis. The incidence and prognosis of reactivation in patients with rheumatoid arthritis (RA) may be different from those receiving organ transplantation and cancer chemotherapy. This study aimed to investigate the incidence, risk factors, and clinical course of HBV reactivation and develop a scoring system for risk stratification in RA patients with resolved infection.
METHODS
HBV DNA was measured using real-time polymerase chain reaction, and patient data were collected for 4 years in RA patients with resolved HBV infection who were treated with steroids or synthetic or biologic immunosuppressive drugs.
RESULTS
Among 1127 patients, HBV DNA was detected in 57 patients (1.65/100 person-years); none of the reactivated patients exhibited worsening of hepatic function. Multivariate logistical analysis revealed that age > 70 years and HB core antibody (HBcAb) positivity alone were independent risk factors for HBV reactivation. HBV DNA ≥ 2.1 log copies/mL was observed in 15 patients (0.43/100 person-years); seven patients were treated with nucleic acid analogs (NAAs), whereas the remaining eight were observed without treatment. Among reactivated cases, 15 cases changed to HBV DNA-negative status spontaneously, whereas 24 cases remained HBV DNA positive < 2.1 log copies/mL during the observation period. We designed the following scoring system: HBV reactivation risk score = 1 × (age > 70 years) + 2 × (HBcAb positivity alone) + 1 × (treatment other than methotrexate monotherapy). This revealed that patients with the highest score had an odds ratio of 13.01 for HBV reactivation, compared to those with the lowest score.
CONCLUSIONS
Rapid progression and poor outcomes after HBV reactivation were not frequent in RA patients with resolved infection. Our new risk scoring system might be useful for screening and optimization of prophylactic treatment by distinguishing patients with significantly lower reactivation risk.
Identifiants
pubmed: 31779676
doi: 10.1186/s13075-019-2053-1
pii: 10.1186/s13075-019-2053-1
pmc: PMC6883521
doi:
Substances chimiques
Antirheumatic Agents
0
Antiviral Agents
0
Hepatitis B Antibodies
0
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
255Références
Clin Exp Rheumatol. 2007 Nov-Dec;25(6):888-9
pubmed: 18173926
Clin Infect Dis. 2008 Sep 1;47(5):e52-6
pubmed: 18643758
Intervirology. 2004;47(1):32-40
pubmed: 15044834
Arthritis Rheum. 2001 Feb;44(2):339-42
pubmed: 11229464
Hepatology. 2007 Feb;45(2):507-39
pubmed: 17256718
Ann Rheum Dis. 2017 Jun;76(6):1051-1056
pubmed: 27934678
Eur J Gastroenterol Hepatol. 2010 Apr;22(4):494-9
pubmed: 20306568
Hepatol Res. 2013 Feb;43(2):97-105
pubmed: 23409848
J Gastroenterol. 2016 Nov;51(11):1081-1089
pubmed: 26943169
J Viral Hepat. 2018 Nov;25(11):1312-1320
pubmed: 29770539
Mod Rheumatol. 2014 Jan;24(1):1-7
pubmed: 24261752
J Gastroenterol. 2016 Oct;51(10):999-1010
pubmed: 26831356
Gastroenterology. 2017 May;152(6):1297-1309
pubmed: 28219691
Hepatol Res. 2014 Jan;44 Suppl S1:1-58
pubmed: 24397839
Arthritis Rheum. 1995 Jan;38(1):44-8
pubmed: 7818570
Clin Exp Rheumatol. 2017 Sep-Oct;35(5):831-836
pubmed: 28375829
J Hepatol. 2012 Jul;57(1):167-85
pubmed: 22436845
J Microbiol Immunol Infect. 2019 Feb;52(1):1-8
pubmed: 29158080
Hepatol Int. 2008 Sep;2(3):263-83
pubmed: 19669255