THU0676 HEPATITIS B VIRUS REACTIVATION IN A COHORT OF PATIENTS TREATED WITH BIOLOGICS – DATA FROM THE ROMANIAN REGISTRY OF RHEUMATIC DISEASES
Authors: Corina Mogosan, Catalin Codreanu, Denisa Predeteanu, Simona Rednic, Magda Parvu, Elena Rezus, Ruxandra Ionescu
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> 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 (pts) who have resolved HBV infection (1). Romania has a high prevalence for HBV infection. According to a national epidemiological study conducted in 2013, 27,9% from the Romanian population has serological markers of resolved HBV infection, while 4.2% of inactive carriers of HBsAg (2). <h3>Objectives:</h3> To estimate the rate of HBV reactivation in a cohort of patients treated with biologics, in Romania. <h3>Methods:</h3> Data were gathered from the Romanian Registry of Rheumatic Diseases (RRBR) for rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The cohort included patients previously exposed to HBV: HBsAg inactive carriers or resolved HBV infection. HBV reactivation was considered as the presence of DNA-HBV or positivity of HBsAg in a previously negative patient. The collected data included exposure to biologics in person-years (PY) and serological markers of HBV. <h3>Results:</h3> The cohort included 1744pts (5505.95 PY): 936 RA pts (2762.97 PY), 640 AS pts (2037.64 PY) and 168 PsA pts (705.34 PY). The mean age was 58.72yrs (65yrs for RA, 49.58yrs for AS, 61.58yrs for PsA); 1058 (60.6%) women: 786 (74.2%) RA pts, 175 (16.5%) AS pts and 97 (9.1%) PsA pts. Mean disease duration was 14.5yrs for RA, 10.7yrs for AS and 10.5yrs for PsA.The prevalence of HBsAg inactive carriers were 44 (4.7%) in RA group, 53 (8.28%) in AS group and 6 (3.57%) in PsA. The frequency of resolved HBV infection was 892 (95.3%) in RA group, 587 (91.7%) in AS and 162 (96.4%) in PsA. The total number of observed HBV reactivation cases was 16 (0.9%). In RA, 9 (0.9%) cases of HBV reactivation (0.31/100 PY) were observed, all cases on resolved HBV infection state; 7 pts were treated with rituximab (RTX), 2 pts with TNFa blockers. 8 cases (0.28/100PY) of HBV reactivation were observed in those without antiviral prophylaxis, compared to a single reactivation case (0.03/100PY) when antiviral prophylaxis was used. In AS cohort occurred 6 (0.9%) cases of HBV reactivation (0.29/100 PY), all patients being treated with TNFa blockers (3 etanercept, 1 adalimumab, 1 infliximab, 1 golimumab): 4 cases of HBV reactivation developed in inactive carriers of HBsAg and 2 in resolved HBV infection. 5 cases (0.24/100PY) of HBV reactivation were observed in those without antiviral prophylaxis, compared to a single reactivation case (0.04/100PY) when antiviral prophylaxis was used. In PsA group, only 1 case of HBV reactivation (0.14/100PY), on inactive carrier of HBsAg state, during TNFa blocking agent (golimumab). <h3>Conclusion:</h3> HBV reactivation appeared more often on a resolved infection state, especially without antiviral prophylaxis. No cases of fulminant hepatitis were noted. Most cases developed in RTX exposed RA patients, while in AS group all HBV reactivation appeared with TNFa blockers exposure. <h3>References:</h3> [1] Shunsuke M, Shigetoshi F. World J Gastroenterol 2015 September 28; 21(36): 10274-10289 [2] https://www.cnscbt.ro/index.php <h3>Disclosure of Interests:</h3> None declared