Mori Shunsuke, Fujiyama Shigetoshi
Shunsuke Mori, Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto 861-1196, Japan.
World J Gastroenterol. 2015 Sep 28;21(36):10274-89. doi: 10.3748/wjg.v21.i36.10274.
Accompanying the increased use of biological and non-biological antirheumatic drugs, a greater number of cases of hepatitis B virus (HBV) reactivation have been reported in inactive hepatitis B surface antigen (HBsAg) carriers and also in HBsAg-negative patients who have resolved HBV infection. The prevalence of resolved infection varies in rheumatic disease patients, ranging from 7.3% to 66%. Through an electronic search of the PubMed database, we found that among 712 patients with resolved infection in 17 observational cohort studies, 12 experienced HBV reactivation (1.7%) during biological antirheumatic therapy. Reactivation rates were 2.4% for etanercept therapy, 0.6% for adalimumab, 0% for infliximab, 8.6% for tocilizumab, and 3.3% for rituximab. Regarding non-biological antirheumatic drugs, HBV reactivation was observed in 10 out of 327 patients with resolved infection from five cohort studies (3.2%). Most of these patients received steroids concomitantly. Outcomes were favorable in rheumatic disease patients. A number of recommendations have been established, but most of the supporting evidence was derived from the oncology and transplantation fields. Compared with patients in these fields, rheumatic disease patients continue treatment with multiple immunosuppressants for longer periods. Optimal frequency and duration of HBV-DNA monitoring and reliable markers for discontinuation of nucleoside analogues should be clarified for rheumatic disease patients with resolved HBV infection.
随着生物和非生物抗风湿药物使用的增加，报告显示，乙肝表面抗原（HBsAg）携带者以及已清除乙肝病毒（HBV）感染的HBsAg阴性患者中，乙肝病毒（HBV）再激活的病例越来越多。已清除感染的风湿性疾病患者患病率各不相同，范围从7.3%至66%。通过对PubMed数据库进行电子检索，我们发现，在17项观察性队列研究的712例已清除感染的患者中，有12例（1.7%）在接受生物抗风湿治疗期间出现HBV再激活。依那西普治疗的再激活率为2.4%，阿达木单抗为0.6%，英夫利昔单抗为0%，托珠单抗为8.6%，利妥昔单抗为3.3%。对于非生物抗风湿药物，在五项队列研究的327例已清除感染的患者中，有10例（3.2%）观察到HBV再激活。这些患者大多同时接受了类固醇治疗。风湿性疾病患者的预后良好。虽然已经制定了一些建议，但大多数支持证据来自肿瘤学和移植领域。与这些领域的患者相比，风湿性疾病患者使用多种免疫抑制剂持续治疗的时间更长。对于已清除HBV感染的风湿性疾病患者，应明确HBV-DNA监测的最佳频率和持续时间以及停用核苷类似物的可靠标志物。
