A.M. Mohareb, MD, E.P. Hyle, MD, MSc, Medical Practice Evaluation Center, and Division of Infectious Diseases, Massachusetts General Hospital, and Harvard Medical School;
N.J. Patel, MD, Harvard Medical School, and Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital.
J Rheumatol. 2022 Jan;49(1):104-109. doi: 10.3899/jrheum.210257. Epub 2021 Aug 1.
Hepatitis B virus (HBV) can reactivate among rheumatology patients initiating tocilizumab (TCZ) or tofacitinib (TOF). HBV screening is recommended by the Centers for Disease Control and Prevention (CDC), the American Association for the Study of Liver Diseases (AASLD), and the Canadian Rheumatology Association, but it is not explicitly recommended by the American College of Rheumatology.
We conducted a cross-sectional study to characterize HBV screening practices for adult rheumatology patients initiating TCZ or TOF before December 31, 2018, in the Greater Boston area. We classified appropriate HBV screening patterns prior to TCZ or TOF (i.e., HBV surface antigen [HBsAg], total core antibody [anti-HBcAb], and surface antibody [HBsAb]) as follows: complete (all 3 tested), partial (any 1 or 2 tests), or none. We determined the frequency of inappropriate HBV testing (HBV e-antigen, anti-HBcAb IgM, or HBV DNA without a positive HBsAg or total anti-HBcAb) and used multivariable regression to assess factors associated with complete HBV screening.
Among 678 subjects initiating TCZ, 194 (29%) completed appropriate HBV screening, 307 (45%) had partial screening, and 177 (26%) had none. Among 391 subjects initiating TOF, 94 (24%) completed appropriate HBV screening, 195 (50%) had partial screening, and 102 (26%) had none. Inappropriate testing was performed in 22% of subjects. Race was associated with complete HBV screening (White vs non-White: OR 0.74, 95% CI 0.57-0.95), whereas prior immunosuppression was not (conventional synthetic disease-modifying antirheumatic drugs [DMARDs]: OR 1.05, 95% CI 0.72-1.55; biologic DMARDs: OR 0.73, 95% CI 0.48-1.12).
Patients initiating TCZ or TOF are infrequently screened for HBV despite recommendations from the AASLD and CDC.
乙型肝炎病毒 (HBV) 可在开始使用托珠单抗 (TCZ) 或托法替布 (TOF) 的风湿病患者中重新激活。疾病控制与预防中心 (CDC)、美国肝病研究协会 (AASLD) 和加拿大风湿病协会建议对 HBV 进行筛查，但美国风湿病学会并未明确推荐。
我们进行了一项横断面研究，以描述 2018 年 12 月 31 日前在大波士顿地区开始使用 TCZ 或 TOF 的成年风湿病患者的 HBV 筛查情况。我们将 TCZ 或 TOF 之前的适当 HBV 筛查模式（即 HBV 表面抗原 [HBsAg]、总核心抗体 [抗-HBcAb] 和表面抗体 [HBsAb]）分为以下几类：完全（所有 3 项均检测）、部分（任何 1 项或 2 项检测）或无。我们确定了不适当的 HBV 检测（HBV e 抗原、抗-HBcAb IgM 或 HBV DNA 而无阳性 HBsAg 或总抗-HBcAb）的频率，并使用多变量回归评估与完全 HBV 筛查相关的因素。
在 678 例开始使用 TCZ 的患者中，194 例（29%）完成了适当的 HBV 筛查，307 例（45%）进行了部分筛查，177 例（26%）未进行筛查。在 391 例开始使用 TOF 的患者中，94 例（24%）完成了适当的 HBV 筛查，195 例（50%）进行了部分筛查，102 例（26%）未进行筛查。22%的患者进行了不适当的检测。种族与完全 HBV 筛查相关（白种人比非白种人：OR 0.74，95%CI 0.57-0.95），而既往免疫抑制治疗无关（传统合成改善病情抗风湿药 [DMARDs]：OR 1.05，95%CI 0.72-1.55；生物 DMARDs：OR 0.73，95%CI 0.48-1.12）。
尽管 AASLD 和 CDC 均有建议，但开始使用 TCZ 或 TOF 的患者对 HBV 的筛查频率仍较低。
