Disease modifying antirheumatics

Abstract

Reactivation of hepatitis-B infection: 7 case reports In a retrospective study involving 152 patients, who were treated with biological disease-modifying antirheumatic drugs (bDMARDs) from April 2009 to July 2016, seven patients (3 men and 4 women) aged 52-78 years were described, who developed reactivation of hepatitis-B infection during treatment with abatacept, golimumab, infliximab or tocilizumab for rheumatoid arthritis. All seven patients, who had rheumatoid arthritis, started receiving bDMARDs, in the form of abatacept (3 patients), golimumab (1 patient), infliximab (2 patients) or tocilizumab [1 patient; dosages and routes not stated]. Additionally, they received methotrexate and unspecified glucocorticoids. The medical history of all patients was significant for a prior, resolved hepatitis-B infection. At baseline, the patients had AST levels varying from 45–49 IU/L, ALT levels varying from 3–58 IU/L and antibodies against hepatitis-B virus surface antigen (anti‐HBs) levels varying from <10–215.2 mIU/mL. After a duration of 1-54 months from therapy initiation, the patients developed reactivation of hepatitis-B infection. The peak levels of hepatitis-B virus DNA varied from <20 (+) to 275 IU/mL; their AST levels varied from 16–49 IU/L, while ALT levels varied from 5–38 IU/L. The treatment with abatacept, golimumab, infliximab or tocilizumab was continued. Two of the seven patients received treatment with entecavir for the reactivation. Subsequently, the patients showed improvement in the anti‐HBs levels. Author comment: Biological disease‐modifying antirheumatic drugs (bDMARDs) have significantly improved the clinical and radiographic outcomes in RA patients. However, these drugs can induce severe infectious complications, in particular the reactivation of latent infections. HBV reactivation occurred in [seven] of RA patients with resolved HBV during the treatment with bDMARDs .