乙型肝炎表面抗原阴性/乙型肝炎核心抗体阳性患者接受生物制剂或 JAK 抑制剂治疗类风湿关节炎后乙型肝炎再激活的风险：一项荟萃分析。

Risk of hepatitis B reactivation in HBsAg-/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta-analysis.

机构信息

Department of Rheumatology and Immunology, The First Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China.

Tianjin hospital, Tianjin, China.

出版信息

Immun Inflamm Dis. 2023 Feb;11(2):e780. doi: 10.1002/iid3.780.

BACKGROUND

The risk of hepatitis B virus (HBV) reactivation after biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) therapy in patients with rheumatoid arthritis (RA) combined with HBsAg-/HBcAb+ is still inconsistent.

METHODS

We conducted a systematic review of existing databases from 1977 to August 22, 2021. Studies of RA patients combined with HBsAg-/HBcAb +, treated with b/tsDMARDs and the reported number of HBV reactivation were included.

RESULTS

We included 26 studies of 2252 HBsAg-/HBcAb+ RA patients treated with b/tsDMARDs. The pooled HBV reactivation rate was 2.0% (95% confidence interval [CI]: 0.01-0.04; I = 66%, p < .01). In the subgroup analysis, the HBV reactivation rate of rituximab (RTX), abatacept, and inhibitors of Janus kinase (JAK), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were 9.0% (95% CI: 0.04-0.15; I = 61%, p = .03), 6.0% (95% CI: 0.01-0.13; I = 40%, p = .19), 1.0% (95% CI: 0.00-0.03; I = 41%, p = .19), 0.0% (95% CI: 0.00-0.02; I = 0%, p = .43), 0.0% (95% CI: 0.00-0.01; I = 0%, p = .87), respectively. While HBsAb- patients have a significant risk of reactivation (odds ratio [OR] = 4.56, 95% CI = 2.45-8.48; I = 7%, p = .37), low HBsAb+ group also display a significant risk of reactivation (OR = 5.45, 95% CI: 1.35-21.94; I = 0%, p = .46).

CONCLUSIONS

This meta-analysis demonstrates the highest potential risk of HBV reactivation in HBsAg-/HBcAb+ RA patients receiving RTX treatment, especially HBsAb- patients. Our study furthers the understanding of the prophylactic use of anti-HBV drugs in such patients. However, it is relative safety to use the inhibitors of IL-6, TNF-α, and JAK in these patients.

背景

乙型肝炎病毒（HBV）在乙型肝炎表面抗原（HBsAg）-/核心抗体（HBcAb）+、类风湿关节炎（RA）患者中接受生物制剂和靶向合成的疾病修饰抗风湿药物（b/tsDMARDs）治疗后发生再激活的风险仍不一致。

方法

我们对从 1977 年到 2021 年 8 月 22 日的现有数据库进行了系统评价。纳入了 HBsAg-/HBcAb+、接受 b/tsDMARDs 治疗且报告 HBV 再激活病例数的 RA 患者的研究。

结果

我们纳入了 26 项共 2252 例 HBsAg-/HBcAb+RA 患者接受 b/tsDMARDs 治疗的研究。HBV 再激活率为 2.0%（95%置信区间[CI]：0.01-0.04；I²=66%，p<.01）。在亚组分析中，利妥昔单抗（RTX）、阿巴西普、Janus 激酶（JAK）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）抑制剂的 HBV 再激活率分别为 9.0%（95%CI：0.04-0.15；I²=61%，p=.03）、6.0%（95%CI：0.01-0.13；I²=40%，p=.19）、1.0%（95%CI：0.00-0.03；I²=41%，p=.19）、0.0%（95%CI：0.00-0.02；I²=0%，p=.43）、0.0%（95%CI：0.00-0.01；I²=0%，p=.87）。而 HBsAb-患者再激活风险显著升高（比值比[OR] = 4.56，95%CI = 2.45-8.48；I²=7%，p=.37），低 HBsAb+组也显示出显著的再激活风险（OR = 5.45，95%CI：1.35-21.94；I²=0%，p=.46）。