FRI0075 Risk of hepatitis b infection reactivation in rheumatic diseases patients treated with anti-cd20 therapy. (12th June 2018)

• Record Type: Journal Article
• Authors: Fornaro, M.; Lopalco, G.; Venerito, V.; Barone, M.; Cantarini, L.; Fabiani, C.; Emmi, G.; Silvestri, E.; Lapadula, G.; Iannone, F.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 583
• Page End: 583
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.6987
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: It has been widely established that the risk of hepatitis B reactivation is high in haematological patients receiving ANTI-CD20 therapy. For these patients the use of prophylaxis with antiretroviral drugs is recommended, and the same approach is also advocated in patients affected with rheumatic diseases, although the real risk seems to be lower. Objectives: To evaluate the risk of HBV infection reactivation in patients with rheumatic diseases undergoing treatment with ANTI-CD20 therapy. Methods: Retrieved data including demographical, therapeutic and clinical features as well as serological data were collected in 92 patients with different rheumatic diseases who underwent treatment with ANTI-CD20 from January 2009 to December 2016. Occult HBV infection at baseline (HBsAg negative, anti-HBcAg positive with or without anti-HBsAg and undetectable HBV-DNA) was observed in 25 patients (18 rheumatoid arthritis, 4 vasculitis, 2 systemic sclerosis and 1 dermatomyositis), none of them was treated with antiretroviral prophylaxis. HBV-DNA value was recorded at least every year, whereas HBsAg together with anti-HBsAg every six months and ALT every three months. Results: During the whole observation period (mean time 39.28±26.6 months) none of the 25 patients (mean age 58.64±8.58 years; 68% women) had hepatitis B reactivation or HBsAg seroreversion. During the evaluated period 2 patients dropped out therapy, 1 stopped treatment for adverse event and 1 for ineffectiveness. After 70 months of therapy 1 patient presented low fluctuation of HBV-DNA title (13 IU/ml), that spontaneously returned negative after 3 months without therapeutic changes. In addition 1 patients shown an ALT increase unrelated to HBV reactivation. Conclusions: In line with previous data, our experience suggests that the risk of hepatitis B reactivation in rheumatic patients undergoing treatment with ANTI-CD20 combined with sDMARD is very low. The regular monitoring of transaminases and hepatitis markers (HBsAg, antiHBsAg and HBV-DNA) during treatment has to be preferred to universal prophylaxis. Disclosure of Interest: None declared