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Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts

Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of bot

Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts   (Citations: 2)
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Background  Screening and prophylactic treatment for hepatitis B virus (HBV) reactivation is recommended for patients who receive immunosuppressive or cytotoxic therapy. The aim of this study was to clarify the prevalence of HBV reactivation in rheumatoid arthritis (RA) patients who had received more than 1 year of immunosuppressive therapy. This study also evaluated guidelines for determining HBV reactivation in patients with RA. Methods  This was a prospective non-randomized, non-controlled study. We enrolled 50 patients with RA who had antibodies against hepatitis B core antigen (anti-HBc) and who had started treatment with disease-modifying anti-rheumatic drugs, including those who had additionally received anti-tumor necrosis factor-α (anti-TNF-α). HBV DNA levels were measured every 2–3 months by a real-time, polymerase chain reaction-based method. Entecavir was administered to patients with HBV DNA levels >2.1 log/ml. Results  The mean observation period was 23 months (range 12–32 months). HBV reactivation occurred in 2 of 5 patients with HBV surface antigen (HBsAg) and in 1 of 45 patients without HBsAg. In patients who received anti-TNF-α therapy, antibodies against HBsAg decreased significantly. Entecavir therapy inhibited HBV amplification and prevented HBV-associated flares of hepatitis. Conclusions  The incidence of HBV reactivation was low in RA patients in whom HBV infection had been resolved. Screening for HBV reactivation and prophylactic therapy with entecavir were effective means of preventing HBV-associated hepatic failure in patients with HBsAg, as well as in those with only anti-HBc who received immunosuppressive therapy for RA.
Journal: Journal of Gastroenterology - J GASTROENTEROLOGY , vol. 46, no. 4, pp. 556-564, 2011
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    • ...A prospective study for Japanese patients with RA and resolved HBV infection has shown that without any anti-HBV prophylaxis, viral reactivation occurred in only one out of 45 patients (2.2%) during immunosuppressive therapy with conventional DMARDs and/or anti-TNFa agents for a mean period of 23 months (range 12‐32 months) [22]...
    • ...Likewise, Tamori et al. [22] have reported that among 5 patients positive for HBsAg, 3 pretreated with entecavir continued to receive MTX or etanercept without hepatic flares, whereas HBV reactivation occurred in the remaining 2 patients who had not received anti-HBV prophylaxis...

    Shunsuke Mori. Past hepatitis B virus infection in rheumatoid arthritis patients rece...

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