Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received conventional disease-modifying antirheumatic drugs
Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received conventional disease-modifying antirheumatic drugs
复制标题
DOI：
10.1007/s10067-012-1988-2
复制
发表时间：
2012-08-01
影响因子：
3.4
通讯作者：
Wei, Jing
中科院分区：
文献类型：
--
作者：
Tan, Jing;Zhou, Jingguo;Wei, Jing
有关类风湿性关节炎(RA)患者乙肝病毒(HBV)再激活的研究已经引起了抗风湿药物(DMARD)相关的乙肝病毒再激活的关注。大多数研究集中在生物DMARD的乙肝病毒再激活风险上；没有足够的数据来确定与传统DMARD(c-DMARD)相关的乙肝病毒再激活的确切风险。这项前瞻性研究旨在调查接受c-DMARDS治疗的乙肝病毒感染的类风湿关节炎患者中乙肝病毒重新激活的风险。在这项前瞻性、非随机、非对照研究中，共筛选出476名RA患者。对乙肝表面抗原(HBs)阳性或抗-HBc阳性的乙肝病毒感染者进行HBVDNA检测，每隔3个月监测一次HBVDNA，每隔2个月或更频繁地进行血清丙氨酸氨基转移酶(ALT)检测。在476例RA患者中，HBs Ag阳性率为6.51%，抗-HBc阳性率为51.1%。211例接受c-DMARDS治疗的患者(其中23例HBs Ag阳性，188例HBs Ag阴性/抗-HBc阳性)中，4例发生了HBV二次活化。HBs Ag阳性和HBs Ag阴性/抗-HBc阳性患者均有发生HBV二次激活的可能。乙肝病毒的重新激活与任何特定的c-DMARD无关。糖皮质激素联合应用和基线时抗-HBs阴性与再激活相关。综上所述，对于乙肝病毒感染的类风湿关节炎患者，根据风险分层而不是普遍预防来开始抗病毒预防是合理的。传统的DMARDS对于低激活风险(低HBVDNA水平，不使用GCs，抗-Hb阳性)的乙肝病毒感染患者相对安全。
Studies that reported hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients have caused attention of disease-modifying antirheumatic drug (DMARD)-related HBV reactivation. Most of the studies were focused on HBV reactivation risk of biologic DMARDs; insufficient data are available to identify the exact risk of conventional DMARD (c-DMARD)-related HBV reactivation. This prospective study aimed to investigate the risk of HBV reactivation in HBV-infected RA patients who received c-DMARDs. A total of 476 RA patients were screened in this prospective non-randomized, non-controlled study. HBV-infected patients characterized by hepatitis B surface antigen (HBsAg) positive or HBsAg negative/anti-hepatitis B core antigen (anti-HBc) positive were analyzed for HBV DNA, followed with HBV DNA monitoring scheduled every 3 months, serum alanine aminotransferase test at 2-month intervals, or more frequently. Prevalence of HBsAg positive and HBsAg negative/anti-HBc positive was 6.51 and 51.1 %, respectively, among the 476 RA patients. Among 211 patients (23 patients were HBsAg positive and 188 patients were HBsAg negative/anti-HBc positive) who received c-DMARDs without antiviral prophylactic treatment, 4 patients developed HBV reactivation. Both HBsAg positive and HBsAg negative/anti-HBc positive patients have the possibility of developing HBV reactivation. There was no correlation between HBV reactivation and any specific c-DMARD. Glucocorticoid coadministration and negative anti-hepatitis B surface antigen (anti-HBs) at baseline showed correlation with reactivation. In conclusion, it would be rational to initiate antiviral prophylaxis according to risk stratification rather than universal prophylaxis for HBV-infected RA patients. Conventional DMARDs are relatively safe to HBV-infected patients with low reactivation risk (low HBV DNA level, no GCs administration, and anti-HB positive).