BACKGROUND/AIMS: Hepatitis B reactivation (HBVR) is an important risk of treatment with tumor necrosis factor inhibitors (anti-TNF). While antiviral prophylaxis is recommended before treatment in HBsAg-positive patients, there is no clear approach for the follow-up or prophylactic treatment of patients with past hepatitis B virus (HBV) infection. The aim of this study was to evaluate patients with past HBV infection treated with anti-TNF for HBVR and/or HBVR-associated biochemical breakthrough. MATERIAL AND METHODS: Patients who received anti-TNF therapy and had past HBV infection (HBsAg negative, anti-HBc IgG positive, anti-HBs negative or positive) were screened and evaluated at 3-month intervals for viral and biochemical breakthrough according to a liver function test (ALT) and HBV DNA level. RESULTS: A total of 653 patients who received anti-TNF therapy were screened. Ninety of these patients had past HBV infection and had not received antiviral prophylaxis. Anti-HBs positivity and isolated anti-HBc IgG positivity were seen in 87.7% (n: 79) and 12.2% (n: 11) of these patients, respectively. No HBVR was seen in 20% (n: 18) of patients who were followed up regularly, and no HBVR-associated biochemical breakthrough was found in patients who were not followed up regularly in terms of HBV DNA level (80%, n: 72) during the follow-up period (26±16 months). CONCLUSION: The use of anti-TNF in patients with past HBV infection has a low risk for HBVR. A follow-up for the ALT and HBV DNA levels at 3-month intervals may be more reasonable than administering antiviral prophylaxis to all patients.
BACKGROUND/AIMS: Hepatitis B reactivation (HBVR) is an important risk of treatment with tumor necrosis factor inhibitors (anti-TNF). While antiviral prophylaxis is recommended before treatment in HBsAg-positive patients, there is no clear approach for the follow-up or prophylactic treatment of patients with past hepatitis B virus (HBV) infection. The aim of this study was to evaluate patients with past HBV infection treated with anti-TNF for HBVR and/or HBVR-associated biochemical breakthrough. MATERIAL AND METHODS:Patients who received anti-TNF therapy and had past HBV infection (HBsAg negative, anti-HBc IgG positive, anti-HBs negative or positive) were screened and evaluated at 3-month intervals for viral and biochemical breakthrough according to a liver function test (ALT) and HBV DNA level. RESULTS: A total of 653 patients who received anti-TNF therapy were screened. Ninety of these patients had past HBV infection and had not received antiviral prophylaxis. Anti-HBs positivity and isolated anti-HBc IgG positivity were seen in 87.7% (n: 79) and 12.2% (n: 11) of these patients, respectively. No HBVR was seen in 20% (n: 18) of patients who were followed up regularly, and no HBVR-associated biochemical breakthrough was found in patients who were not followed up regularly in terms of HBV DNA level (80%, n: 72) during the follow-up period (26±16 months). CONCLUSION: The use of anti-TNF in patients with past HBV infection has a low risk for HBVR. A follow-up for the ALT and HBV DNA levels at 3-month intervals may be more reasonable than administering antiviral prophylaxis to all patients.
Authors: Norah A Terrault; Anna S F Lok; Brian J McMahon; Kyong-Mi Chang; Jessica P Hwang; Maureen M Jonas; Robert S Brown; Natalie H Bzowej; John B Wong Journal: Hepatology Date: 2018-04 Impact factor: 17.425
Authors: K Rajender Reddy; Kimberly L Beavers; Sarah P Hammond; Joseph K Lim; Yngve T Falck-Ytter Journal: Gastroenterology Date: 2014-10-31 Impact factor: 22.682
Authors: Jasvinder A Singh; Kenneth G Saag; S Louis Bridges; Elie A Akl; Raveendhara R Bannuru; Matthew C Sullivan; Elizaveta Vaysbrot; Christine McNaughton; Mikala Osani; Robert H Shmerling; Jeffrey R Curtis; Daniel E Furst; Deborah Parks; Arthur Kavanaugh; James O'Dell; Charles King; Amye Leong; Eric L Matteson; John T Schousboe; Barbara Drevlow; Seth Ginsberg; James Grober; E William St Clair; Elizabeth Tindall; Amy S Miller; Timothy McAlindon Journal: Arthritis Rheumatol Date: 2015-11-06 Impact factor: 10.995
Authors: J F Rahier; S Ben-Horin; Y Chowers; C Conlon; P De Munter; G D'Haens; E Domènech; R Eliakim; A Eser; J Frater; M Gassull; M Giladi; A Kaser; M Lémann; T Moreels; A Moschen; R Pollok; W Reinisch; M Schunter; E F Stange; H Tilg; G Van Assche; N Viget; B Vucelic; A Walsh; G Weiss; Y Yazdanpanah; Y Zabana; S P L Travis; J F Colombel Journal: J Crohns Colitis Date: 2009-04-26 Impact factor: 9.071