title: Use of biological disease-modifying anti-rheumatic drugs in patients with concurrent rheumatic disease and hepatitis B.
abstract: BACKGROUND
  Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in the management of inflammatory arthritides. Reactivation of hepatitis B virus (HBV) is a potential adverse outcome in patients treated with bDMARDs. There is currently no consensus on the approach to identifying and treating these patients with underlying HBV infection.
  
  
  OBJECTIVE
  The aims of this study were to assess the risk of HBV reactivation in patients treated with bDMARDs, and to determine whether HBV screening should be carried out in all patients prior to commencing bDMARDs.
  
  
  METHODS
  A literature search was undertaken to identify all reports of patients with inflammatory arthritides and concurrent HBV infection being treated with bDMARDs.
  
  
  RESULTS
  Forty-three patients with HBV infection were identified, of whom eight patients developed HBV reactivation after exposure to bDMARDs. Of the patients who experienced reactivation, two had unknown infection that surfaced during bDMARD therapy. Patients who experienced reactivation were promptly treated with antiviral therapy and saw clinical improvement. There are no long-term data on these patients.
  
  
  CONCLUSIONS
  HBV reactivation may result in serious consequences, including death. Tuberculosis screening prior to bDMARD treatment is already standard practice, as is HBV screening for patients undergoing cancer chemotherapy. Implementing HBV screening for all patients prior to bDMARD treatment can identify patients with chronic HBV who may require antiviral therapy.
authors.affiliation: Concord Clinical School, Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: L K
authors.initials: LK
authors.lastname: King
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Anandacoomarasamy
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects / Q000502:physiology; D011928:Raynaud Disease / Q000188:drug therapy / Q000453:epidemiology; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents