Nakamura Jun, Nagashima Takao, Nagatani Katsuya, Yoshio Taku, Iwamoto Masahiro, Minota Seiji
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Int J Rheum Dis. 2016 May;19(5):470-5. doi: 10.1111/1756-185X.12359. Epub 2014 Apr 4.
To examine the incidence of hepatitis B virus (HBV) reactivation in patients with rheumatoid arthritis (RA) receiving biological disease-modifying antirheumatic drugs (DMARDs).
We retrospectively reviewed RA patients treated with biological DMARDs at our institution from July 2010 to December 2012. Patients with antibodies for hepatitis B core antigen and/or hepatitis B surface antigen were regarded as having prior HBV infection. Clinical data on these patients, including HBV-DNA levels, were retrieved from the medical records.
During the study period, 251 patients were administered various biological DMARDs. Six patients with a history of HBV vaccination and one patient with positive HBV surface antigen were excluded from the study. Fifty-seven of the remaining 244 patients (23.4%) had prior HBV infection. These patients were followed for a median of 18 months (range: 2-27 months) and HBV-DNA was examined a median of seven times (range: 2-27). HBV-DNA was detected in three patients (5.3%), comprising two receiving tocilizumab and one receiving etanercept. However, HBV-DNA levels were below the quantitation limit (<2.1 log copies mL(-1) ) in all three patients. HBV-DNA became negative again within several months in all three patients, while biological DMARDs were continued and liver function tests remained normal throughout.
HBV-DNA reactivation occurred in 5.3% of RA patients with prior HBV infection during treatment with biological DMARDs, but there were no associated clinical manifestations. Accordingly, it seems that biological DMARDs can be used safely in patients with RA.
研究类风湿关节炎（RA）患者接受生物性改善病情抗风湿药（DMARDs）治疗时乙肝病毒（HBV）再激活的发生率。
我们回顾性分析了2010年7月至2012年12月在我院接受生物性DMARDs治疗的RA患者。乙肝核心抗原抗体和/或乙肝表面抗原抗体阳性的患者被视为既往有HBV感染。从病历中获取这些患者的临床资料，包括HBV-DNA水平。
在研究期间，251例患者接受了各种生物性DMARDs治疗。6例有HBV疫苗接种史的患者和1例乙肝表面抗原阳性的患者被排除在研究之外。其余244例患者中有57例（23.4%）既往有HBV感染。这些患者的中位随访时间为18个月（范围：2 - 27个月），HBV-DNA的检测中位次数为7次（范围：2 - 27次）。3例患者（5.3%）检测到HBV-DNA，其中2例接受托珠单抗治疗，1例接受依那西普治疗。然而，所有3例患者的HBV-DNA水平均低于定量下限（<2.1 log拷贝/mL(-1)）。所有3例患者在数月内HBV-DNA再次转阴，同时继续使用生物性DMARDs，且肝功能检查始终正常。
在接受生物性DMARDs治疗的既往有HBV感染的RA患者中，HBV-DNA再激活的发生率为5.3%，但无相关临床表现。因此，生物性DMARDs似乎可以在RA患者中安全使用。
