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Incidence and clinical characteristics of hepatitis B virus reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab for rheumatoid arthritis

1, 2, 3

 

  1. Allergy, Immunology and Rheumatology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
  2. Gastroenterology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City; and General Education Center, Chienkuo Technology University, Changhua City, Taiwan.
  3. Allergy, Immunology and Rheumatology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua City; and Department of Nursing, College of Medicine and Nursing, Hung Kuang University, Taichung City, Taiwan. 129273@cch.org.tw

CER10011
2017 Vol.35, N°5
PI 0831, PF 0836
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PMID: 28375829 [PubMed]

Received: 12/10/2016
Accepted : 14/02/2017
In Press: 31/03/2017
Published: 15/09/2017

Abstract

OBJECTIVES:
To analyse the incidence, clinical characteristics, and prognosis of patients with rheumatoid arthritis (RA) and hepatitis B virus (HBV) surface antigen negative/core antibody positive serostatus (HBsAg-/HBcAb+), who underwent rituximab therapy and developed HBV reactivation.
METHODS:
Medical records of RA patients with different HBV serostatus who received rituximab from January 2000 through January 2015 were reviewed. Case notes of four HBsAg-/HBcAb+ patients with RA who had HBV reactivation during treatment with rituximab were excerpted and summarised. We also searched the Medline (PubMed) database to identify published reports of other HBsAg-/HBcAb+ RA patients who likewise developed HBV reactivation during rituximab treatment.
RESULTS:
The study cohort comprised 54 RA patients who received rituximab, of whom 44 (81.5%) were HBsAg-/HBcAb+ whilst receiving rituximab. Four HBsAg-/HBcAb+ patients had HBV reactivations during rituximab therapy; thus, the incidence of HBV reactivation in the HBsAg-/HBcAb+ group was 9.1%. The literature search discovered another three cases, making a total of at least seven known rituximab-treated HBsAg-/HBcAb+ RA patients who have developed HBV reactivation. The mean duration from the first rituximab infusion to HBV reactivation was 25.4±4.6 months; no fatalities occurred.
CONCLUSIONS:
Approximately 9% of Taiwanese RA patients with HBsAg-/HBcAb+ serostatus had HBV reactivation around 2 years after starting regular rituximab therapy; they all had a relatively good prognosis.

Rheumatology Article