RESEARCH- Safety of TNF-blocking agents in rheumatic patients with possible past hepatitis B

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Arthritis Research & Therapy 2009, 11:R179doi:10.1186/ar2868

Research article

Safety of TNF-blocking agents in rheumatic patients with serology

suggesting past hepatitis B state: results from a cohort of 21

patients

Caroline Charpin1* , Sandrine Guis1* , Philippe Colson2,3 ,

Borentain4 , Jean-Pierre Mattéi1 , Patrice Alcaraz1 , Nathalie

Balandraud1 , Benoit Thomachot1 , Roudier1 and René Gérolami4

1 Service de Rhumatologie, Centre Hospitalier Universitaire

Conception, 147 Boulevard Baille, 13385 Marseille, France

2 Laboratoire de Virologie, Fédération Hospitalière de Microbiologie

Clinique, Centre Hospitalo-Universitaire Timone, 264 Rue Saint-Pierre,

13385 Marseille, France

3 URMITE CNRS-IRD UMR 6236, Facultés de Médecine et de Pharmacie,

Université de la Méditerranée, 27 Boulevard Moulin, 13385

Marseille, France

4 Service d'Hépato-gastroentérologie, Centre Hospitalier

Universitaire Conception, 147 Boulevard Baille, 13385 Marseille,

France

Abstract

Introduction

Reactivation of hepatitis B virus (HBV) infection in patients with

past infection has been described in 5% to 10% of individuals

undergoing immunosuppressive therapies. No data are available to date

on the outcome of patients treated by tumour necrosis factor-alpha

(TNFα) inhibitors for chronic arthritis with a serological pattern of

past HBV infection. The aim of our study was to monitor HBV markers in

HBV surface antigen (HBsAg)-negative/anti-HBcAb-positive patients

treated with a TNFα inhibitor for inflammatory arthritides.

Methods

Twenty-one HBsAg-negative/anti-HBcAb-positive patients were included.

HBV serological patterns were compared with those determined before

starting TNFα inhibitors. Serum HBV DNA testing by polymerase chain

reaction was additionally performed. Spearman correlation analysis was

used and P < 0.05 was chosen as the significance threshold.

Results

Before starting therapy, mean anti-HBsAb titre was 725 IU/L, no

patient had an anti-HBsAb titre <10 IU/L, and 18 patients had an

anti-HBsAb >100 IU/L. At a mean time of 27.2 months following therapy

introduction, mean anti-HBsAb titre was 675 IU/L and anti-HBsAb titre

remained >100 IU/L in 17 patients. There was a strong correlation

between the first and second anti-HBsAb titres (r = 0.98, P = 0.013).

Moreover, no patient had an anti-HBsAb titre below 10 IU/L or HBV

reactivation (HBsAg seroreversion or positive HBV DNA detection).

However, the anti-HBsAb titre decreased by more than 30% in 6

patients. The mean anti-HBsAb titre at baseline was significantly

lower (P = 0.006) and the mean duration of anti-TNFα therapy, although

non-significant (P = 0.09), was longer in these six patients as

compared to patients without a decrease in anti-HBsAb titre.

Conclusions

Anti-TNFα treatments are likely to be safe in patients with past

hepatitis B serological pattern. However, the significant decrease of

anti-HBsAb titre observed in a proportion of patients deserves HBV

virological follow-up in these patients, especially in those with a

low anti-HBsAb titre at baseline.

http://arthritis-research.com/content/11/6/R179/abstract

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