Short-Course Tocilizumab May Increase HBV Reactivation in RA

HealthDay News — For patients with rheumatoid arthritis (RA), 1 to 3 doses of tocilizumab may increase the risk of hepatitis B virus (HBV) reactivation, according to a study published in the International Journal of Rheumatic Diseases.

Le-Feng Chen, from Sun Yat-Sen Memorial Hospital in Guangzhou, China, and colleagues recruited RA patients with moderate-to-high disease activity, with at least one feature of poor prognosis and an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Three doses of intravenous tocilizumab were combined with csDMARDS. Data were included for 63 RA patients with chronic HBV infection (7 patients), resolved HBV infection (41 patients), and non-HBV infection (15 patients).

The researchers found that after 1 to 3 doses of tocilizumab, 3 patients with chronic HBV and without antiviral prophylaxis developed HBV reactivation. They were asymptomatic and had normal aminotransferases; after therapeutic antiviral therapy, the HBV-DNA of 3 patients with HBV reactivation became undetectable. 

In patients with resolved HBV infection there was no HBV reactivation. Aminotransferase elevation occurred in 22% of all patients, but the elevation was at least 2-fold of normal range in only 2 patients.

“This prospective clinical observation preliminarily indicated 3-dose tocilizumab combined with csDMARDs might increase the risk of HBV reactivation in RA patients with chronic HBV infection, but in this study patients remained asymptomatic and had a benign outcome after antiviral treatment,” the authors write.

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Chen LF, Mo Y-Q, Jing J, Ma J-D, Zheng D-H, Dai L. Short-course tocilizumab increases risk of hepatitis B virus reactivation in patients with rheumatoid arthritis: a prospective clinical observation [published online February 3, 2017]. Int J Rheum Dis. doi: 10.1111/1756-185X.13010