BIOLOGICS THERAPY FOR PATIENTS WITH RHEUMATOID ARTHRITIS AND HEPATITIS B INFECTION

Background: Biologics suppress hepatitis B virus (HBV) replication and play an important role in eradicating HBV by stimulating HBV-specific cytotoxic T-cell responses. We found that HBV reactivates or flares after biologics therapy in patients with chronic hepatitis B infection and in those with inactive hepatitis B surface antigen (HBs-Ag). The guideline, prevention of immunosuppressive-induced reactivation of HBV infection, recommend nucleoside analogs for treating patients with rheumatoid arthritis (RA) who are positive for HBs-Ag. We describe six patients who underwent biological therapy with the nucleoside analog entecavir (ETV). Objectives: We aimed to determine the safety of biological therapy in patients with RA carrying hepatitis B by evaluating clinical characteristics and changes in serological and biological markers of HBV reactivation. Methods: Six patients with RA who screened positive for HBs-Ag were prescribed with ETV under the direction of a hepatologist when HBV-DNA levels decreased to <2.1 log copies/mL. The patients were also treated with infliximab (n = 1), etanercept (n = 2), adalimumab (n = 2) and tocilizumab (n = 1) (Table 1). We evaluated the disease activity score of RA (DAS28-ESR), HBV markers and genotype before starting treatment as well as changes in the amount of HBV-DNA, HBs-Ag and alanine aminotransferase (ALT). Results: The average age, duration of RA and DAS28-ESRat baseline was 54.7 years, 10.9 years and 5.51, respectively. The minimum HBs-Ag value is 12.2 and three patients had values over >2000 before starting ETV therapy. The pre-treatment values of HBV-DNA and ALT were 4.28 log copies/mL and 20.2 U/L, respectively. Reactivation of HBV was not confirmed during 2.1 years the patients were treated with these agents. Hepatitis B viral DNA was undetectable in five patients and <2.1 log copies/mL in one. The DAS28-ESR was 3.14 at final follow-up and disease RA activity remained low (Table 1). Conclusions: Antiviral prophylaxis protected against HBV reactivation in patients with RA, indicating that biologics are relatively safe for treating such patients. Biologics could serve as a useful treatment for hepatitis B carriers who are simultaneously prescribed with nucleoside analogs under the control of a hepatologist. References: 1.Ganem D, Prince AM. Hepatitis B virus infection-natural history and clinical consequences. N Engl J Med. 2004; 350:1118-29. 2.Tamori A, Koike T, Goto H, et al. Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts. J Gastroenterol. 2011; 46:556-64. Disclosure of Interest: M. Tada Grant/research support from: Japan Osteoporosis Foundation grant 2013, T. Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, A. Tamori: None Declared, T. Okano: None Declared, Y. Sugioka: None Declared, K. Mamoto: None Declared, K. Inui: None Declared, H. Nakamura: None DeclaredCitation: , volume 72, supplement s3, year 2013, page Session: Poster session Friday ( )