PMID- 28850029
OWN - NLM
STAT- MEDLINE
DCOM- 20180424
LR  - 20220317
IS  - 0392-856X (Print)
IS  - 0392-856X (Linking)
VI  - 36
IP  - 1
DP  - 2018 Jan-Feb
TI  - Liver safety of non-tumour necrosis factor inhibitors in rheumatic patients with 
      past hepatitis B virus infection: an observational, controlled, long-term study.
PG  - 102-109
AB  - OBJECTIVES: The risk of hepatitis B virus (HBV) reactivation with non-tumour 
      necrosis factor inhibitor (non-TNFi) biologic agents in patients with rheumatic 
      diseases and past HBV infection has not been definively elucidated. We assessed 
      the comparative safety of non-TNFi and TNFi biologic agents in such patients in 
      real-life clinical settings. METGODS: We carried out a retrospective cohort study 
      from the Department of Rheumatology, University Hospital of Heraklion. Patients 
      who received abatacept (ABA), tocilizumab (TCZ) or rituximab (RTX) during the 
      period 2003-2016 and were HbsAg(-), anti-HBc(+), anti-HBs(+/-) at baseline, were 
      monitored for HBV reactivation. Patients treated with TNFi agents during the same 
      period were used as a control group. RESULTS: 101 cases of non-TNFi (39 ABA, 32 
      RTX and 30 TCZ) and 111 cases of TNFi treatment were identified. In non-TNFi, 76 
      cases (75.2%) were anti-HBc(+)/anti-HBs(+) and 25 (24.8%) were 
      anti-HBc(+)/anti-HBs(-), as compared to 82 (73.9%) and 29 (26.1%) in 
      TNFi-treated, respectively. After a median (IQR) observation of 24.0 (34.7) 
      months, two cases (2.0%) of HBV reactivation were identified in the non-TNFi 
      group; one with ABA, successfully treated with entecavir, and one fatal case with 
      RTX and prior exposure to cyclophosphamide. No reactivation was observed in the 
      TNFi group (p=0.226 vs. non-TNFi). Alphanti-HBs titres were significantly reduced 
      compared to baseline in the non-TNFi group [median (IQR) 203.9 (954.7) mIU/ml 
      before treatment versus 144.9 (962.9) mIU/ml after treatment, p=0.03]. 
      CONCLUSIONS: Two cases of HBV reactivation highlight the risk for this 
      complication in patients with past HBV infection under biologic therapy.
FAU - Papalopoulos, Ioannis
AU  - Papalopoulos I
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Fanouriakis, Antonis
AU  - Fanouriakis A
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion; and Laboratory of Clinical Virology, Medical School, University of 
      Crete, Heraklion, Greece. afanouriakis@edu.med.uoc.gr.
FAU - Kougkas, Nikolaos
AU  - Kougkas N
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Flouri, Irini
AU  - Flouri I
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Sourvinos, George
AU  - Sourvinos G
AD  - Rheumatology and Clinical Immunology Unit, 4th Department of Internal Medicine, 
      "Attikon" University Hospital, Athens, Greece.
FAU - Bertsias, George
AU  - Bertsias G
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Repa, Argyro
AU  - Repa A
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Avgoustidis, Nestor
AU  - Avgoustidis N
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
FAU - Sidiropoulos, Prodromos
AU  - Sidiropoulos P
AD  - Department of Rheumatology, Clinical Immunology and Allergy, University Hospital 
      of Heraklion, Greece.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20170828
PL  - Italy
TA  - Clin Exp Rheumatol
JT  - Clinical and experimental rheumatology
JID - 8308521
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antirheumatic Agents/*adverse effects
MH  - Arthritis, Rheumatoid/diagnosis/*drug therapy/immunology
MH  - Biological Products/*adverse effects
MH  - Chemical and Drug Induced Liver Injury/diagnosis/*etiology
MH  - Female
MH  - Greece
MH  - Hepatitis B/diagnosis/immunology/*virology
MH  - Hepatitis B virus/immunology/*pathogenicity
MH  - Humans
MH  - Immunocompromised Host
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/antagonists & inhibitors/immunology
MH  - *Virus Activation
EDAT- 2017/08/30 06:00
MHDA- 2018/04/25 06:00
CRDT- 2017/08/30 06:00
PHST- 2017/01/22 00:00 [received]
PHST- 2017/05/29 00:00 [accepted]
PHST- 2017/08/30 06:00 [pubmed]
PHST- 2018/04/25 06:00 [medline]
PHST- 2017/08/30 06:00 [entrez]
AID - 11543 [pii]
PST - ppublish
SO  - Clin Exp Rheumatol. 2018 Jan-Feb;36(1):102-109. Epub 2017 Aug 28.