Biyolojik ve Hedefe Yönelik Sentetik Hastalık Modifiye Edici Antiromatizmal İlaçlarla Tedavi Edilen Romatizmal Hastalarda Hepatit B ve C virüs Seroprevalansının ve Antiviral Profilaksi Oranlarının İncelenmesi: Orta Anadolu’daki Üçüncü Basamak Bir Merkezden Sonuçlar
Abstract
Amaç: Biyolojik ve hedefe yönelik sentetik hastalık modifiye edici antiromatizmal ilaçlar (DMARD) ile tedavi edilen romatizmal hastalarda hepatit B virüsü (HBV) ve hepatit C virüsü (HCV)’nün epidemiyolojik özelliklerini değerlendirmek.
Gereç ve Yöntem: Bu kesitsel çalışma Eylül 2021 ile Nisan 2022 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Romatoloji Polikliniği'nde gerçekleştirildi ve 200 hasta [113'ü aksiyal spondiloartrit (akSpA), 18'i psöriyatik artrit (PsA) ve 69'u romatoid artrit (RA)]) dahil edildi. Hastaların demografik ve klinik özellikleri, tedavi detayları ve viral hepatit serolojileri kaydedildi. Biyolojik ve/veya hedefe yönelik sentetik DMARD (b/tsDMARD) almayanlar çalışmadan dışlandı.
Bulgular: Hastaların medyan yaşı 47 (39-58) yıl, medyan hastalık süresi ise 10 (7-15) yıldı. 117'si (%58,5) kadın, 83'ü (%41,5) erkekti. B/tsDMARD ile medyan tedavi süresi 6 (2-9) yıldı. Viral serolojik incelemelerde hastaların %1,5'inde HBsAg, %64,5'inde anti-HBs, %23,5'inde anti-HBc IgG ve %0,5'inde anti-HCV pozitifliği tespit edildi. Anti-HBc IgG pozitifliği oranı RA hastalarında (%34,8) axSpA hastalarına (%16,8) göre anlamlı derecede yüksekti ve PsA hastalarına (%22,2) benzerdi (p = 0,023). Ancak HBsAg, anti-HBs ve anti-HCV serolojileri hasta alt grupları arasında benzerdi (p > 0,05). Toplam 44 (%22) hasta oral antiviral profilaksi tedavisi altındaydı. Anti-HBc pozitif ve HBV DNA negatif olan 3 (%1,5) hasta antiviral tedavi uygulanmadan takip edildi. Hiçbir hastada viral reaktivasyon görülmedi.
Sonuç: Kohortumuzdaki yaklaşık dört hastadan biri anti-Hbc pozitifliği gösterdi ve neredeyse tamamı antiviral profilaksi kullanıyordu. Anti-HCV prevalansı çok daha düşüktü. Romatizmal hastalarda ve/veya hasta alt gruplarında viral hepatitleri ele alan hem ulusal hem de yerel düzeydeki çalışmalar, romatologların HBV ve HCV'yi yönetmede daha etkin olmalarını sağlayacaktır.
References
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- Min HK, Kim SH, Kim H-R, Lee S-H. Therapeutic Utility and adverse effects of biologic disease-modifying anti-rheumatic drugs in inflammatory arthritis. Int J Mol Sci 2022;23(22):13913.
- Evangelatos G, Bamias G, Kitas GD, Kollias G, Sfikakis PP. The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022;42(9):1493-1511.
- Sarzi-Puttini P, Ceribelli A, Marotto D, Batticciotto A, Atzeni F. Systemic rheumatic diseases: from biological agents to small molecules. Autoimmun Rev 2019;18(6):583-592.
- Michelsen B, Fiane R, Diamantopoulos AP, Soldal DM, Hansen IJW, Sokka T, et al. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PloS One 2015;10(4):e0123582.
- Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19-34.
- Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, Campanholo CB, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 2022;18(8):465-479.
- Smolen JS, Landewé RB, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 2023;82(1):3-18.
- Cheah JT, Faragon JJ, Marks KM. Management of hepatitis B and C infections in rheumatologic disease. Best Practice & Research Clinical Rheumatology. 2018;32(6):848-68.
- Dağlı Ö, Aksoy MK. Hepatitis B and hepatitis C infection prevalence in ankylosing spondylitis patients. Ortadoğu Tıp Dergisi. 2018;10(3):297-301.
- Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, et al. Guideline of the viral hepatitis screening before biologic agents use in patients with rheumatic diseases. RAEDDergisi 2015;7(1):28–32.
- Capkin E, Yazıcı A, Karkucak M, Durmaz Y, Toprak M, Ataman Ş, et al. Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study. Rheumatol Int 2023;43(3):523-531.
- Duygu Ersözlü E, Ekici M, Coşkun B, Badak S, Bilgin E, Kalyoncu U. Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from treasure database. Arch Rheumatol. 2023;38(x):i-xi.
- Hansu K, Cikim IG. Comparison of hepatitis B surface antigen, anti-hepatitis B surface, and anti-hepatitis C virus prevalence in Syrian refugee pregnant women and Turkish pregnant women. Rev Assoc Med Bras (1992) 2023;69:e20221446.
- Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015;21(11):1020-1026.
- Coskun BN, Yağız B, Özboz ES, Tufan AN, Ermurat S, Pehlivan Y, et al. Hepatitis B and C virus reactivations under biologic treatments in patients with rheumatic diseases: long-term results from a single-center. Eur Res J 2022;8(2):162-168.
- Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl 2):ii1-ii44.
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- Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham III CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569-2581.
- Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS‐G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ‐S). Arthritis Care Res (Hoboken) 2011;63(S11):S47-S58.
- Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 2016;75(5):811-818.
- Greenmyer JR, Stacy JM, Sahmoun AE, Beal JR, Diri E. DAS28‐CRP cutoffs for high disease activity and remission are lower than DAS28‐ESR in rheumatoid arthritis. ACR Open Rheumatol 2020;2(9):507-511.
- Sarin S, Kumar M, Lau G, Abbas Z, Chan H, Chen C, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016;10:1-98.
- Leone GM, Mangano K, Petralia MC, Nicoletti F, Fagone P. Past, Present and (Foreseeable) Future of Biological Anti-TNF Alpha Therapy. J Clin Med 2023;12(4):1630.
- Radu A-F, Bungau SG. Management of rheumatoid arthritis: an overview. Cells 2021;10(11):2857.
- Mok CC. Hepatitis B and C infection in patients undergoing biologic and targeted therapies for rheumatic diseases. Best Pract Res Clin Rheumatol 2018;32(6):767-780.
- Su Y-C, Lin P-C, Yu H-C, Wu C-C. Hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving chemotherapy or immunosuppressive therapy. Eur J Gastroenterol Hepatol 2018;30(8):925-929.
- Lin TC, Yoshida K, Tedeschi SK, de Abreu MM, Hashemi N, Solomon DH. Risk of hepatitis B virus reactivation in patients with inflammatory arthritis receiving disease‐modifying antirheumatic drugs: a systematic review and meta‐analysis. Arthritis Care Res (Hoboken) 2018;70(5):724-731.
- Zhou Q, Zhang Q, Wang K, Huang T, Deng S, Wang Y, et al. Anti-rheumatic drug-induced hepatitis B virus reactivation and preventive strategies for hepatocellular carcinoma. Pharmacol Res 2022;178:106181.
- Yılmaz N, Karadağ Ö, Kimyon G, Yazıcı A, Yılmaz S, Kalyoncu U, et al. Prevalence of hepatitis B and C infections in rheumatoid arthritis and ankylosing spondylitis: A multicenter countrywide study. Eur J Rheumatol 2014;1(2):51.
Examining the Seroprevalance and Antiviral Prophylaxis Rate of Hepatitis B and C Virus in Rheumatic Patients Treated with Biological and Targeted Synthetic Disease Modifying Anti-rheumatic Drugs: Results from a Tertiary Center in Central Anatolia
Abstract
Objective: To evaluate the epidemiological characteristics of hepatitis B virus (HBV) and hepatitis C virus (HCV) in rheumatic patients treated with biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs).
Methods: This cross-sectional study was carried out between September 2021 and April 2022 at the Rheumatology Outpatient Clinic of Erciyes University Faculty of Medicine, and it included 200 patients [113 with axial spondyloarthritis (axSpA), 18 with psoriatic arthritis (PsA) and 69 with rheumatoid arthritis (RA)]. The demographic and clinical characteristics, treatment details and viral hepatitis serology of the patients were recorded. Those not receiving biological and/or targeted synthetic DMARDs (b/tsDMARDs) were excluded.
Results: The median age of the patients was 47 (39-58) years, and the median disease duration was 10 (7-15) years. 117 (58.5%) of the patients were female, and 83 (41.5%) were male. The median duration of treatment with b/tsDMARDs was 6 (2-9) years. In the viral serological examinations, 1.5% of the patients were positive for HBsAg, 64.5% for anti-HBs, 23.5% for anti-HBc IgG, and 0.5% for anti-HCV. The anti-HBc IgG positivity rate was significantly higher in RA (34.8%) than axSpA patients (16.8%) and was similar to PsA patients (22.2%) (p = 0.023). Yet HBsAg, anti-HBs, and anti-HCV serologies were similar across patient subgroups (p > 0.05). A total of 44 (22%) patients were undergoing oral antiviral prophylaxis. Three (1.5%) patients who were anti-HBc positive and HBV DNA negative were followed without antiviral treatment. There was no viral reactivation in any patient.
Conclusion: Approximately one in four patients in our cohort showed anti-Hbc positivity, and almost all of them were using antiviral prophylaxis. Anti-HCV prevalence was much lower. Studies addressing viral hepatitis in rheumatic patients and/or patient subgroups, both at the national and local level, will enable rheumatologists to be more effective in managing HBV and HCV.
Ethical Statement
This study was approved by the Erciyes University Clinical Research Ethics Committee (Date:22 September 2021, Approval Number:2021/612). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all patients.
References
- Wong PK, Bagga H, Barrett C, Chong G, Hanrahan P, Kodali T, et al. A practical approach to the use of conventional synthetic, biologic and targeted synthetic disease modifying anti-rheumatic drugs for the treatment of inflammatory arthritis in patients with a history of malignancy. Curr Rheumatol Rep 2018;20:1-13.
- Min HK, Kim SH, Kim H-R, Lee S-H. Therapeutic Utility and adverse effects of biologic disease-modifying anti-rheumatic drugs in inflammatory arthritis. Int J Mol Sci 2022;23(22):13913.
- Evangelatos G, Bamias G, Kitas GD, Kollias G, Sfikakis PP. The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022;42(9):1493-1511.
- Sarzi-Puttini P, Ceribelli A, Marotto D, Batticciotto A, Atzeni F. Systemic rheumatic diseases: from biological agents to small molecules. Autoimmun Rev 2019;18(6):583-592.
- Michelsen B, Fiane R, Diamantopoulos AP, Soldal DM, Hansen IJW, Sokka T, et al. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PloS One 2015;10(4):e0123582.
- Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19-34.
- Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, Campanholo CB, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 2022;18(8):465-479.
- Smolen JS, Landewé RB, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 2023;82(1):3-18.
- Cheah JT, Faragon JJ, Marks KM. Management of hepatitis B and C infections in rheumatologic disease. Best Practice & Research Clinical Rheumatology. 2018;32(6):848-68.
- Dağlı Ö, Aksoy MK. Hepatitis B and hepatitis C infection prevalence in ankylosing spondylitis patients. Ortadoğu Tıp Dergisi. 2018;10(3):297-301.
- Karadağ Ö, Kaşifoğlu T, Özer B, Kaymakoğlu S, Kuş Y, İnanç M, et al. Guideline of the viral hepatitis screening before biologic agents use in patients with rheumatic diseases. RAEDDergisi 2015;7(1):28–32.
- Capkin E, Yazıcı A, Karkucak M, Durmaz Y, Toprak M, Ataman Ş, et al. Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study. Rheumatol Int 2023;43(3):523-531.
- Duygu Ersözlü E, Ekici M, Coşkun B, Badak S, Bilgin E, Kalyoncu U. Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from treasure database. Arch Rheumatol. 2023;38(x):i-xi.
- Hansu K, Cikim IG. Comparison of hepatitis B surface antigen, anti-hepatitis B surface, and anti-hepatitis C virus prevalence in Syrian refugee pregnant women and Turkish pregnant women. Rev Assoc Med Bras (1992) 2023;69:e20221446.
- Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015;21(11):1020-1026.
- Coskun BN, Yağız B, Özboz ES, Tufan AN, Ermurat S, Pehlivan Y, et al. Hepatitis B and C virus reactivations under biologic treatments in patients with rheumatic diseases: long-term results from a single-center. Eur Res J 2022;8(2):162-168.
- Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl 2):ii1-ii44.
- Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54(8):2665-2673.
- Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham III CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569-2581.
- Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS‐G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ‐S). Arthritis Care Res (Hoboken) 2011;63(S11):S47-S58.
- Schoels MM, Aletaha D, Alasti F, Smolen JS. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 2016;75(5):811-818.
- Greenmyer JR, Stacy JM, Sahmoun AE, Beal JR, Diri E. DAS28‐CRP cutoffs for high disease activity and remission are lower than DAS28‐ESR in rheumatoid arthritis. ACR Open Rheumatol 2020;2(9):507-511.
- Sarin S, Kumar M, Lau G, Abbas Z, Chan H, Chen C, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016;10:1-98.
- Leone GM, Mangano K, Petralia MC, Nicoletti F, Fagone P. Past, Present and (Foreseeable) Future of Biological Anti-TNF Alpha Therapy. J Clin Med 2023;12(4):1630.
- Radu A-F, Bungau SG. Management of rheumatoid arthritis: an overview. Cells 2021;10(11):2857.
- Mok CC. Hepatitis B and C infection in patients undergoing biologic and targeted therapies for rheumatic diseases. Best Pract Res Clin Rheumatol 2018;32(6):767-780.
- Su Y-C, Lin P-C, Yu H-C, Wu C-C. Hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving chemotherapy or immunosuppressive therapy. Eur J Gastroenterol Hepatol 2018;30(8):925-929.
- Lin TC, Yoshida K, Tedeschi SK, de Abreu MM, Hashemi N, Solomon DH. Risk of hepatitis B virus reactivation in patients with inflammatory arthritis receiving disease‐modifying antirheumatic drugs: a systematic review and meta‐analysis. Arthritis Care Res (Hoboken) 2018;70(5):724-731.
- Zhou Q, Zhang Q, Wang K, Huang T, Deng S, Wang Y, et al. Anti-rheumatic drug-induced hepatitis B virus reactivation and preventive strategies for hepatocellular carcinoma. Pharmacol Res 2022;178:106181.
- Yılmaz N, Karadağ Ö, Kimyon G, Yazıcı A, Yılmaz S, Kalyoncu U, et al. Prevalence of hepatitis B and C infections in rheumatoid arthritis and ankylosing spondylitis: A multicenter countrywide study. Eur J Rheumatol 2014;1(2):51.
Details
| Primary Language | English |
|---|---|
| Subjects | Rheumatology and Arthritis |
| Journal Section | Original Article |
| Authors | |
| Early Pub Date | February 26, 2024 |
| Publication Date | February 29, 2024 |
| Submission Date | September 18, 2023 |
| Published in Issue | Year 2024 Volume: 34 Issue: 1 |
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