In a recent study presented during the European League Against Rheumatism Annual European Congress of Rheumatology (EULAR), a team of researchers found that hepatitis B reactivation after treatment with biologic treatment for rheumatic conditions or IBD was unlikely.
The study included a sample of patients with Hepatitis B (HBV), wherein the patients’ serologies were analyzed. Of the total sample group, 224 had IBD and 710 patients had rheumatic disease.
All patients in the study were AgHBs-negative, and 72 patients were anti-HBc with an undetectable viral load. At the beginning of the biologic therapy treatment, patients had a median disease duration of 6.6 years, nearly two-thirds of the patients with anti-HBc were women, and they had a median age 54.1 years.
A total of 61 anti-HBc-positive patients were diagnosed with a rheumatic condition. Of these, 31 patients received a diagnosis of rheumatoid arthritis, 10 patients were diagnosed with psoriatic arthritis, and 12 patients were diagnosed with ankylosing spondylitis. Ten patients had Crohn’s disease, eleven had IBD, and one patient had ulcerative colitis.
The majority of the patients (38.9%) who were anti-HBc-positive were prescribed with the biological agent Remicade (infliximab, Janssen), followed by 31.9% of the patients that were treated with Enbrel (etanercept, Amgen), 12.5% of the patients were treated with Humira (adalimumab, AbbVie), and with Actemra (tocilizumab, Genentech), Simponi (golimumab, Janssen) and Rituxan (rituximab, Genentech). Each of these biological agents was prescribed to 5.6% of the patients.
Forty-four patients were given concomitant treatment with methotrexate and forty-three patients were prescribed with other non-biologic disease-modifying anti-rheumatic drugs (DMARDs). Fifty-one patients were prescribed with corticosteroids. The researchers did not give patients any prophylactic antiviral therapy. Discontinuation of a biologic agent during follow-up was seen in 5.6% of the patients.
As part of the study, a woman with acute HBV and Crohn’s disease was found to have HB reactivation. The initial treatment for this case was with azathioprine and adalimumab. Following a poor clinical response, the researchers switched the patient to infliximab. At that time, the patient was not anti-HB positive. The researchers observed that there was a HBV reactivation after 3 months of infliximab inception, and the researchers decided to discontinue Infliximab and observed that the patient recovered with antiviral therapy.
These findings have expanded the understanding of the ramifications of utilizing biologic medications with IBD and rheumatic conditions, and their potential impact on the recurrence of HBV, giving physicians much-needed insights into how to manage these comorbidities together,