Baseline hepatitis B surface antigen (HBsAg) positivity is a significant protective factor for reactivation of hepatitis B virus (rHBV) in patients with HBsAg-negative, HBV core antibody (HBcAg)-positive rheumatoid arthritis (RA) receiving rituximab (RTX) therapy, according to study results published in the International Journal of Rheumatic Diseases.1

Worldwide, approximately 2 billion people are infected by HBV, and 75% of them inhabit Southeast Asia and the Western Pacific regions.2,3 A considerable number of patients with RA have coexisting HBV infection, and RA is a risk factor for developing rHBV as a result of using immunosuppressive therapies.4-7 RTX is used for treating patients with RA with an inadequate response to anti-tumor necrosis factor (TNF)-alpha therapy, and rHBV has recently been recognized as a complication of RTX therapy.8-18

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Therefore, researchers in Taiwan examined the occurrence of rHBV in 157 patients with RA who were receiving RTX therapy.1 They found that of these patients, 103 (65.6%) were HBsAg-negative and HBcAb-positive. However, before RTX therapy, 20 (19.4%) of these 103 patients were HBsAg-negative, while 83 (80.1%) were HBsAb-positive. Of the patients who tested HBsAb-negative, 5 (20%) developed rHBV after RTX therapy and of the 83 patients who tested HBsAb-positive, 4 (4.8%) developed rHBV. Of the 9 patients with rHBV, 7 (77.7%) exhibited HBsAg seroconversion. Overall, a significant decline of HBsAg titers was observed in patients who were HBsAg-negative/HBsAb-positive, and HBsAb positivity was found to be an independent protective factor for rHBV (P =.009).

“In conclusion, our results showed that RTX therapy can induce rHBV in the early phase for HBsAg‐positive patients and in the late phase for those with resolved HBV infection,” stated the investigators.1 They added that, “Future prospective studies are needed to investigate the optimal frequency of HBV‐DNA monitoring, and the optimal duration of antiviral therapy in RA patients receiving RTX therapy.”

References

1. Chen Y‐M, Chen H‐H, Huang W‐N, et al. Reactivation of hepatitis B virus infection following rituximab treatment in HBsAg‐negative, HBcAb‐positive rheumatoid arthritis patients: A long‐term, real‐world observation [published online May 22, 2019]. Int J Rheum Dis. doi:10.1111/1756-185X.13582

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