title: Viral hepatitis screening guideline before biological drug use in rheumatic patients.
abstract: Biological drugs (tumor necrosis factor inhibitors, rituximab, tocilizumab, abatacept, and tofacitinib) are important treatment alternatives in rheumatology, particularly for resistant patients. However, they may cause hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation; for instance, HBV reactivation may occur in a patient who is an inactive hepatitis B surface antigen (HBsAg) carrier or who has resolved HBV infection. Therefore, the screening of patients before biological treatment and the application of a prophylactic treatment, particularly with respect to latent HBV infections, are recommended when necessary. This guideline covers pre-treatment screening and follow-up recommendations, if required, with respect to viral hepatitides in rheumatology patients who are planned to be given biological drugs. Although this guideline is prepared for biological disease-modifying antirheumatic drugs (DMARDs), it is recommended to be used also for target-oriented DMARDS and medium-high dose corticosteroids (>7.5 mg prednisolone/day equivalent). It should be considered that the reactivation risk is higher when more than one immunosuppressive drug is used.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Karadağ
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Osmangazi University School of Medicine, Eskişehir, Turkey.
authors.forename: Timuçin
authors.initials: T
authors.lastname: Kaşifoğlu
authors.affiliation: Department of Gastroenterology, Başkent University, School of Medicine, Adana, Turkey.
authors.forename: Birol
authors.initials: B
authors.lastname: Özer
authors.affiliation: Department of Gastroenterohepatology, İstanbul University School of Medicine, İstanbul, Turkey.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Kaymakoğlu
authors.affiliation: Senior Scientific Advisor at Bristol-Myers Squibb, İstanbul, Turkey.
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Kuş
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, İstanbul University School of Medicine, İstanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: İnanç
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Keser
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Kiraz
keywords: Viral hepatitis; biologic drugs; rheumatic patients