Risk of hepatitis B reactivation in patients receiving anti-tumor necrosis factor-α therapy

Int J Rheum Dis. 2021 Feb;24(2):254-259. doi: 10.1111/1756-185X.14034. Epub 2020 Nov 27.

Abstract

Objective: The purpose of this study was to determine hepatitis B virus (HBV) screening rates in patients receiving anti-tumor necrosis factor (TNF)-α therapy and the frequency of HBV reactivation in patients with resolved hepatitis B virus infection (hepatitis B surface antigen [HBsAg] negative, hepatitis B core antibody [Anti-HBc] positive).

Patients and methods: Data from 1834 patients who underwent anti-TNF-α therapy in the Rheumatology, Gastroenterology and Dermatology Departments of our hospital between 2010 and 2020 were retrospectively analyzed. Within 6 months before the initial anti-TNF-α therapy, performing a HBsAg and/or anti-HBc test is defined as HBV screening. HBV reactivation is defined as the presence of detectable serum HBV DNA or HBsAg seroconversion from negative to positive.

Results: The overall HBV screening rate was 82.3% before starting anti-TNF-α therapy. There was an increasing trend in HBV screening rates during the years analyzed (64% in 2010, 87.4% in 2019) (P < .001). Before anti-TNF-α therapy was initiated, 272 patients were HBsAg negative and anti-HBc positive. Among these patients, HBV reactivation did not occur in 31 patients who received antiviral prophylaxis, whereas HBV reactivation occurred in only 1 (0.4%) of the 241 patients who did not receive antiviral prophylaxis.

Conclusion: Hepatitis B virus screening rates prior to starting anti-TNF-α therapy were relatively high, and its trend was increased by year. HBV reactivation because of anti-TNF-α use rarely occurred in patients with resolved HBV infection. Further studies are needed on whether routine anti-HBc screening and/or HBV DNA follow-up are necessary in these patients aside from HBsAg.

Keywords: anti-tumor necrosis factor therapy; antirheumatic therapy; hepatitis B; hepatitis B virus reactivation; hepatitis B virus screening.

MeSH terms

  • Adalimumab / therapeutic use*
  • Anti-Inflammatory Agents / therapeutic use
  • DNA, Viral / analysis
  • Female
  • Follow-Up Studies
  • Hepatitis B / drug therapy*
  • Hepatitis B / immunology
  • Hepatitis B / virology
  • Hepatitis B Antibodies / analysis
  • Hepatitis B Surface Antigens / analysis
  • Hepatitis B virus / genetics*
  • Hepatitis B virus / immunology
  • Humans
  • Immunotherapy / methods*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rituximab / therapeutic use*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Virus Activation / drug effects*

Substances

  • Anti-Inflammatory Agents
  • DNA, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Tumor Necrosis Factor-alpha
  • Rituximab
  • Adalimumab