A study has identified risk factors for hepatitis B virus (HBV) reactivation among patients with rheumatoid arthritis (RA) who received biological disease-modifying antirheumatic drugs (bDMARDs).

 Prof Yi-Hsiang Huang, MD, PhD, National Yang Ming Chiao Tung University School of Medicine, Taipei City, Taiwan, presented these findings at the 2021 American Association for the Study of Liver Diseases meeting.

This study examined risk factors for HBV reactivation among patients with rheumatoid arthritis and resolved hepatis B after treatment with bDMARDs. Researchers reviewed patients with RA and available hepatitis B surface antigen and related antibodies.

A total of 489 patients were included in the study. Researchers analyzed clinical and virological factors associated with HBV reactivation.

The incidence of hepatitis B surface antigen reverse seroconversion after bDMARD treatment was 5.5%. Patients with hepatitis B surface antigen reverse seroconversion were older, had lower frequency of antibodies, and lower baseline antibody levels compared to those without HBV reactivation.

In addition, incidence of hepatitis B surface antigen reverse seroconversion was the highest by rituximab, followed by abatacept, TNF-α inhibitors, and tocilizumab (incidence per 1000 patient years: 17.17, 9.375, .992, and .000, respectively).

Results from multivariate analysis revealed receipt of rituximab (adjusted HR 87.76; 95% CI 11.50–669.73, P <.001), receipt of abatacept (adjusted HR 60.57, 95% CI 6.99–525.15, P <.001), and baseline antibody negativity (adjusted HR 5.15, 95% CI 2.21–12.02, P <.001) were independent risk factors for hepatitis B surface antigen reverse seroconversion.

Rituximab and abatacept were reported to possibly result in loss of antibody to hepatitis B surface antigen. High baseline antibody levels (>100 mIU/ml) were associated with lower risk of antibody loss (1.8% vs 20.5%, P <.001).

Huang et al concluded that both rituximab and abatacept have high risk of HBV reactivation in patients with RA and resolved hepatitis B.

“Abatacept should be classified as high risk of HBV reactivation in RHB [resolved hepatitis B] cases if… [antibody to hepatitis B surface antigen] levels are not high enough, at which, antiviral prophylaxis is highly recommended,” they wrote.

—Janelle Bradley

Reference

Huang Y, et al. HBV Reactivation in Rheumatic Patients With Resolved Hepatitis B Ongoing Biologics Treatment. Presented at: The American Association for the Study of Liver Diseases meeting, November 12-15, 2021; virtual.