Department of Rheumatology and Hematology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, People's Republic of China.
Clin Rheumatol. 2012 Aug;31(8):1169-75. doi: 10.1007/s10067-012-1988-2. Epub 2012 Apr 28.
Studies that reported hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients have caused attention of disease-modifying antirheumatic drug (DMARD)-related HBV reactivation. Most of the studies were focused on HBV reactivation risk of biologic DMARDs; insufficient data are available to identify the exact risk of conventional DMARD (c-DMARD)-related HBV reactivation. This prospective study aimed to investigate the risk of HBV reactivation in HBV-infected RA patients who received c-DMARDs. A total of 476 RA patients were screened in this prospective non-randomized, non-controlled study. HBV-infected patients characterized by hepatitis B surface antigen (HBsAg) positive or HBsAg negative/anti-hepatitis B core antigen (anti-HBc) positive were analyzed for HBV DNA, followed with HBV DNA monitoring scheduled every 3 months, serum alanine aminotransferase test at 2-month intervals, or more frequently. Prevalence of HBsAg positive and HBsAg negative/anti-HBc positive was 6.51 and 51.1 %, respectively, among the 476 RA patients. Among 211 patients (23 patients were HBsAg positive and 188 patients were HBsAg negative/anti-HBc positive) who received c-DMARDs without antiviral prophylactic treatment, 4 patients developed HBV reactivation. Both HBsAg positive and HBsAg negative/anti-HBc positive patients have the possibility of developing HBV reactivation. There was no correlation between HBV reactivation and any specific c-DMARD. Glucocorticoid coadministration and negative anti-hepatitis B surface antigen (anti-HBs) at baseline showed correlation with reactivation. In conclusion, it would be rational to initiate antiviral prophylaxis according to risk stratification rather than universal prophylaxis for HBV-infected RA patients. Conventional DMARDs are relatively safe to HBV-infected patients with low reactivation risk (low HBV DNA level, no GCs administration, and anti-HB positive).
本研究旨在探讨接受传统疾病修饰抗风湿药物（c-DMARD）治疗的乙型肝炎病毒（HBV）感染的类风湿关节炎（RA）患者发生 HBV 再激活的风险。在这项前瞻性非随机、非对照研究中，共筛选了 476 例 RA 患者。对 HBV 感染患者（乙型肝炎表面抗原 [HBsAg] 阳性或 HBsAg 阴性/抗乙型肝炎核心抗原 [抗-HBc] 阳性）进行 HBV DNA 检测，并在 HBV DNA 监测每 3 个月、每 2 个月检测血清丙氨酸氨基转移酶（ALT）或更频繁的情况下进行 HBV DNA 监测。476 例 RA 患者中，HBsAg 阳性和 HBsAg 阴性/抗-HBc 阳性的患者分别占 6.51%和 51.1%。在接受 c-DMARD 治疗而未进行抗病毒预防性治疗的 211 例患者（23 例 HBsAg 阳性，188 例 HBsAg 阴性/抗-HBc 阳性）中，有 4 例发生 HBV 再激活。HBsAg 阳性和 HBsAg 阴性/抗-HBc 阳性患者均有发生 HBV 再激活的可能。HBV 再激活与任何特定的 c-DMARD 之间均无相关性。糖皮质激素联合治疗和基线时抗乙型肝炎表面抗原（抗-HBs）阴性与再激活相关。总之，对于 HBV 感染的 RA 患者，根据风险分层而非普遍预防来启动抗病毒预防是合理的。对于低再激活风险（低 HBV DNA 水平、无 GC 治疗和抗-HB 阳性）的 HBV 感染患者，传统 DMARD 相对安全。
