title: Hepatitis B virus reactivation in HBsAg-positive patients with rheumatic diseases undergoing anti-tumor necrosis factor therapy or DMARDs.
abstract: OBJECTIVE
  The aim of this study was to assess the effects of anti-tumor necrosis factor (TNF) agents or disease-modifying antirheumatic drugs (DMARDs) on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients with rheumatic diseases.
  
  
  METHODS
  Evidence of HBV reactivation after anti-TNF therapy or DMARDs in HBsAg-positive patients with rheumatic disease was summarized by performing a systematic review.
  
  
  RESULTS
  A total of 122 HBsAg-positive rheumatic disease-positive patients undergoing treatment with an anti-TNF agent or with DMARDs were identified in nine studies. In eight of the studies, the anti-TNF agents used were etanercept in 56 cases, adalimumab in 25 cases and infliximab in 14 cases. Follow-up periods ranged from 6 to 52 months. Antiviral prophylaxis was administrated in 48 of the 122 patients (39.3%). HBV reactivation in HBsAg-positive patients taking an anti-TNF agent or DMARD was reported in 15 cases (15/122 = 12.3%). Ten of the 15 patients provided individual data on HBV reactivation: four patients had rheumatoid arthritis, four had ankylosing spondylitis and two had psoriatic arthritis; four received etanercept, and two received infliximab. In one of the four etanercept-treated cases in which the patient had elevated HBV-DNA levels, antiviral prophylaxis was also administered. Antiviral treatment was also administered in seven patients receiving other treatments: lamivudine in one, adefovir in one and entecavir in five. Clinical outcomes were satisfactory in all 10 cases of HBV reactivation.
  
  
  CONCLUSIONS
  Hepatitis B virus reactivation was found in 15 (12.3%) patients among the 122 HBsAg-positive patients with rheumatic diseases treated with anti-TNF agents or DMARDs.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Sang-Cheol
authors.initials: SC
authors.lastname: Bae
authors.forename: Gwan Gyu
authors.initials: GG
authors.lastname: Song
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D001688:Biological Products / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D018501:Antirheumatic Agents; D000998:Antiviral Agents; D001688:Biological Products; D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D014409:Tumor Necrosis Factor-alpha
keywords: DMARD; anti-tumor necrosis factor therapy; hepatitis B virus reactivation; rheumatic diseases