Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis
Abstract Background The risk of hepatitis B virus (HBV) reactivation after biologic and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) therapy in patients with rheumatoid arthritis (RA) combined with HBsAg–/HBcAb+ is still inconsistent. Methods We conducted a systematic review...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Immunity, Inflammation and Disease |
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| Online Access: | https://doi.org/10.1002/iid3.780 |
| _version_ | 1797816593583964160 |
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| author | Xuezhi Hong Yanhua Xiao Liyan Xu Lei Liu Hailu Mo Hanyou Mo |
| author_facet | Xuezhi Hong Yanhua Xiao Liyan Xu Lei Liu Hailu Mo Hanyou Mo |
| author_sort | Xuezhi Hong |
| collection | DOAJ |
| description | Abstract Background The risk of hepatitis B virus (HBV) reactivation after biologic and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) therapy in patients with rheumatoid arthritis (RA) combined with HBsAg–/HBcAb+ is still inconsistent. Methods We conducted a systematic review of existing databases from 1977 to August 22, 2021. Studies of RA patients combined with HBsAg−/HBcAb +, treated with b/tsDMARDs and the reported number of HBV reactivation were included. Results We included 26 studies of 2252 HBsAg−/HBcAb+ RA patients treated with b/tsDMARDs. The pooled HBV reactivation rate was 2.0% (95% confidence interval [CI]: 0.01−0.04; I2 = 66%, p < .01). In the subgroup analysis, the HBV reactivation rate of rituximab (RTX), abatacept, and inhibitors of Janus kinase (JAK), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNF‐α) were 9.0% (95% CI: 0.04−0.15; I2 = 61%, p = .03), 6.0% (95% CI: 0.01−0.13; I2 = 40%, p = .19), 1.0% (95% CI: 0.00−0.03; I2 = 41%, p = .19), 0.0% (95% CI: 0.00−0.02; I2 = 0%, p = .43), 0.0% (95% CI: 0.00−0.01; I2 = 0%, p = .87), respectively. While HBsAb‐ patients have a significant risk of reactivation (odds ratio [OR] = 4.56, 95% CI = 2.45−8.48; I2 = 7%, p = .37), low HBsAb+ group also display a significant risk of reactivation (OR = 5.45, 95% CI: 1.35−21.94; I2 = 0%, p = .46). Conclusions This meta‐analysis demonstrates the highest potential risk of HBV reactivation in HBsAg−/HBcAb+ RA patients receiving RTX treatment, especially HBsAb− patients. Our study furthers the understanding of the prophylactic use of anti‐HBV drugs in such patients. However, it is relative safety to use the inhibitors of IL‐6, TNF‐α, and JAK in these patients. |
| first_indexed | 2024-03-13T08:40:58Z |
| format | Article |
| id | doaj.art-4c6b7efbba3e4ca3b865b89ea98bb4fd |
| institution | Directory Open Access Journal |
| issn | 2050-4527 |
| language | English |
| last_indexed | 2024-03-13T08:40:58Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Immunity, Inflammation and Disease |
| spelling | doaj.art-4c6b7efbba3e4ca3b865b89ea98bb4fd2023-05-30T12:15:45ZengWileyImmunity, Inflammation and Disease2050-45272023-02-01112n/an/a10.1002/iid3.780Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysisXuezhi Hong0Yanhua Xiao1Liyan Xu2Lei Liu3Hailu Mo4Hanyou Mo5Department of Rheumatology and Immunology The First Affiliated Hospital of Guilin Medical University Guilin People's Republic of ChinaDepartment of Rheumatology and Immunology The First Affiliated Hospital of Guilin Medical University Guilin People's Republic of ChinaTianjin hospital Tianjin ChinaDepartment of Rheumatology and Immunology The First Affiliated Hospital of Guilin Medical University Guilin People's Republic of ChinaDepartment of Rheumatology and Immunology The First Affiliated Hospital of Guilin Medical University Guilin People's Republic of ChinaDepartment of Rheumatology and Immunology The First Affiliated Hospital of Guilin Medical University Guilin People's Republic of ChinaAbstract Background The risk of hepatitis B virus (HBV) reactivation after biologic and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) therapy in patients with rheumatoid arthritis (RA) combined with HBsAg–/HBcAb+ is still inconsistent. Methods We conducted a systematic review of existing databases from 1977 to August 22, 2021. Studies of RA patients combined with HBsAg−/HBcAb +, treated with b/tsDMARDs and the reported number of HBV reactivation were included. Results We included 26 studies of 2252 HBsAg−/HBcAb+ RA patients treated with b/tsDMARDs. The pooled HBV reactivation rate was 2.0% (95% confidence interval [CI]: 0.01−0.04; I2 = 66%, p < .01). In the subgroup analysis, the HBV reactivation rate of rituximab (RTX), abatacept, and inhibitors of Janus kinase (JAK), interleukin‐6 (IL‐6), and tumor necrosis factor‐α (TNF‐α) were 9.0% (95% CI: 0.04−0.15; I2 = 61%, p = .03), 6.0% (95% CI: 0.01−0.13; I2 = 40%, p = .19), 1.0% (95% CI: 0.00−0.03; I2 = 41%, p = .19), 0.0% (95% CI: 0.00−0.02; I2 = 0%, p = .43), 0.0% (95% CI: 0.00−0.01; I2 = 0%, p = .87), respectively. While HBsAb‐ patients have a significant risk of reactivation (odds ratio [OR] = 4.56, 95% CI = 2.45−8.48; I2 = 7%, p = .37), low HBsAb+ group also display a significant risk of reactivation (OR = 5.45, 95% CI: 1.35−21.94; I2 = 0%, p = .46). Conclusions This meta‐analysis demonstrates the highest potential risk of HBV reactivation in HBsAg−/HBcAb+ RA patients receiving RTX treatment, especially HBsAb− patients. Our study furthers the understanding of the prophylactic use of anti‐HBV drugs in such patients. However, it is relative safety to use the inhibitors of IL‐6, TNF‐α, and JAK in these patients.https://doi.org/10.1002/iid3.780biologic therapyhepatitis B virusreactivationrheumatoid arthritis |
| spellingShingle | Xuezhi Hong Yanhua Xiao Liyan Xu Lei Liu Hailu Mo Hanyou Mo Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis Immunity, Inflammation and Disease biologic therapy hepatitis B virus reactivation rheumatoid arthritis |
| title | Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis |
| title_full | Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis |
| title_fullStr | Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis |
| title_full_unstemmed | Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis |
| title_short | Risk of hepatitis B reactivation in HBsAg−/HBcAb+ patients after biologic or JAK inhibitor therapy for rheumatoid arthritis: A meta‐analysis |
| title_sort | risk of hepatitis b reactivation in hbsag hbcab patients after biologic or jak inhibitor therapy for rheumatoid arthritis a meta analysis |
| topic | biologic therapy hepatitis B virus reactivation rheumatoid arthritis |
| url | https://doi.org/10.1002/iid3.780 |
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