FRI0173 Biologics therapy for patients with rheumatoid arthritis and hepatitis b infection
Authors: M. Tada, T. Koike, A. Tamori, T. Okano, Y. Sugioka, K. Mamoto, K. Inui, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Biologics suppress hepatitis B virus (HBV) replication and play an important role in eradicating HBV by stimulating HBV-specific cytotoxic T-cell responses<sup>1</sup>. We found that HBV reactivates or flares after biologics therapy in patients with chronic hepatitis B infection and in those with inactive hepatitis B surface antigen (HBs-Ag)<sup>2</sup>. The guideline, prevention of immunosuppressive-induced reactivation of HBV infection, recommend nucleoside analogs for treating patients with rheumatoid arthritis (RA) who are positive for HBs-Ag. We describe six patients who underwent biological therapy with the nucleoside analog entecavir (ETV). <h3>Objectives</h3> We aimed to determine the safety of biological therapy in patients with RA carrying hepatitis B by evaluating clinical characteristics and changes in serological and biological markers of HBV reactivation. <h3>Methods</h3> Six patients with RA who screened positive for HBs-Ag were prescribed with ETV under the direction of a hepatologist when HBV-DNA levels decreased to &lt;2.1 log copies/mL. The patients were also treated with infliximab (n = 1), etanercept (n = 2), adalimumab (n = 2) and tocilizumab (n = 1) (Table 1). We evaluated the disease activity score of RA (DAS28-ESR), HBV markers and genotype before starting treatment as well as changes in the amount of HBV-DNA, HBs-Ag and alanine aminotransferase (ALT). <h3>Results</h3> The average age, duration of RA and DAS28-ESRat baseline was 54.7 years, 10.9 years and 5.51, respectively. The minimum HBs-Ag value is 12.2 and three patients had values over &gt;2000 before starting ETV therapy. The pre-treatment values of HBV-DNA and ALT were 4.28 log copies/mL and 20.2 U/L, respectively. Reactivation of HBV was not confirmed during 2.1 years the patients were treated with these agents. Hepatitis B viral DNA was undetectable in five patients and &lt;2.1 log copies/mL in one. The DAS28-ESR was 3.14 at final follow-up and disease RA activity remained low (Table 1). <h3>Conclusions</h3> Antiviral prophylaxis protected against HBV reactivation in patients with RA, indicating that biologics are relatively safe for treating such patients. Biologics could serve as a useful treatment for hepatitis B carriers who are simultaneously prescribed with nucleoside analogs under the control of a hepatologist. <h3>References</h3> Ganem D, Prince AM. Hepatitis B virus infection-natural history and clinical consequences. <i>N Engl J Med</i>. 2004; 350:1118-29. Tamori A, Koike T, Goto H, et al. Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts. <i>J Gastroenterol</i>. 2011; 46:556-64. <h3>Disclosure of Interest</h3> M. Tada Grant/research support from: Japan Osteoporosis Foundation grant 2013, T. Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, A. Tamori: None Declared, T. Okano: None Declared, Y. Sugioka: None Declared, K. Mamoto: None Declared, K. Inui: None Declared, H. Nakamura: None Declared