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Kinetic profiles and management of hepatitis B virus reactivation in patients with immune-mediated inflammatory diseases.

Abstract：

OBJECTIVE:Immunosuppressive therapy may trigger hepatitis B virus (HBV) reactivation for increased morbidity and mortality. We aimed to describe HBV reactivation in patients receiving treatment for immune-mediated inflammatory diseases (IMIDs) and to evaluate a predefined algorithm for its prevention. METHODS:Physicians submitted data for patients receiving treatment for IMIDs and exhibiting HBV reactivation, defined as an increase of >1 log10 IU/ml of HBV DNA levels or DNA reappearance. We systematically reviewed cases in the literature. RESULTS:The 35 physician-collected patients had rheumatoid arthritis (n = 14), connective tissue disease (n = 7), vasculitis (n = 5), and other diseases (n = 9). At baseline, 65.7% of patients were positive for hepatitis B surface antigen (HBsAg), 31.4% had a history of HBV infection, and 2.9% had occult HBV infection. Reactivation occurred a median of 35 weeks (range 2-397 weeks) after the start of corticosteroid and/or immunosuppressive therapy. In all, 88.6% of patients were clinically asymptomatic, but 25.7% had severe hepatitis; none had fulminant hepatitis. Management was antiviral therapy for 91.4%, with discontinuation or decrease of immunosuppressive therapy for 45.7%. In pooling these 35 cases and 103 patients from the literature, 73.9% of patients were clinically asymptomatic, 33.3% had severe hepatitis, and 12.3% died and/or had fulminant hepatitis. Reactivation occurred early with rituximab or cyclophosphamide therapy and in HBsAg-positive/HBV DNA-positive patients. Using the predefined algorithm, 78% of patients with reactivation would have received preemptive antiviral therapy. CONCLUSION:We provide new insights into HBV reactivation in patients receiving treatment for IMIDs. A predefined algorithm may be effective in reducing the risk of HBV reactivation in this population.

journal_name

Arthritis Care Res (Hoboken)

journal_title

Arthritis care & research

authors

Droz N,Gilardin L,Cacoub P,Berenbaum F,Wendling D,Godeau B,Piette AM,Dernis E,Ebbo M,Fautrel B,Le Guenno G,Mekinian A,Bernard-Chabert B,Costedoat-Chalumeau N,Descloux E,Michot JM,Radenne S,Rigolet A,Rivière S,Yvin J

doi

10.1002/acr.21990

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

1504-14

issue

eissn

2151-464X

issn

2151-4658

journal_volume

pub_type

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Kinetic profiles and management of hepatitis B virus reactivation in patients with immune-mediated inflammatory diseases.