Table 6.
Case reports of hepatitis B virus reactivation in rheumatoid arthritis patients undergoing abatacept
| Ref. | Study design | Patients characteristics | Therapy | Basal virological status | Timing of HBV reactivation | Antiviral therapy | Results | Comments |
| Kim et al[95] | Retrospective | 8 RA pts affected with CHB | ABA + pre-emptive NAs (4 pts: 3 with entecavir and 1 with tenofovir) ABA without antiviral prophylaxis (4 pts) | HBsAg+ Detectable HBV-DNA in 3/8 pts | Not specified | Not specified | Among pts receiving NAs, no cases of HBv reactivation. Among pts without antiviral prophylaxis, all pts experienced HBV reactivation | Among pts receiving NAs, a statistically significant improve in DAS28-ERS was detected; which was not noted in the control group |
| Germanidis et al[96] | Case Report | 72-year-old female RA pt starting ABA after ADA | ABA + leflunomide | Anti-HBc+/HBsAg-/anti-HBs+/anti-HBe+ | 6 mo after ABA start | ABA and leflunomide withdrawal Consequent anviral treatment with tenofovir (12 about 1 yr later) | Good clinical, serological and virological response to tenofovir | 2 mo time lag between ABA withdrawal and liver tests flare, suggesting that HBV reactivation evolved in parallel with T cell immune reconstitution |
| Fanouriakis et al[97] | Case report | 68-year-old female RA pt with erosive disease | ABA + methotrexate | HBsAg-/anti-HBc+ Basal HBV-DNA unknown | 10 mo after ABA start | Tenofovir ABA withdrawal | Good clinical, serological and virological response | - |
| De Nard et al[98] | Case series | 9 RA pts treated with ABA | ABA 8/9 pts treated with concomitant methotrexate Lamivudine in 2 pts (1 HBsAg+ and 1 HBsAg-) from baseline, and in 1 pt with comorbid HCV infection after ABA start | 8 HBsAg-/anti-HBc+ 1 HBsAg+/HBV-DNA- | 1 pt with comorbid HCV infection experienced aminotransferases elevation (< 2 x ULN) 2 mo after ABA start | Lamivudine Ongoing ABA | Subclinical, gradual amelioration of liver function tests, persistently undetectable HBV-DNA | No cases of HBV reactivation among pts receiving pre-emptive NAs |
| 1 pt with resolved HBV infection not receiving NAs developed HBV-DNA positivation 12 mo after ABA start | Ongoing ABA No prophylaxis | ConsecutiveHBV-DNA fluctuations; no flares in liver function tests even after entecavir initiation at 24 mo while switching to ADA (unpublished data) | ||||||
| Droz et al[38] | Retrospective (subgroup analysis) | 1 pt affected with immune-mediated inflammatory disease treated with ABA | Not specified | Not specified | median of 35 wk after therapy start (global data) | Not specified | No cases of fulminant hepatitis (global data) | Early reactivation in HBsAg+/HBV-DNA+ pts (global data) |
Pts: Patients; CHB: Chronic hepatitis B; NAs: Nucleot(s)ide analogues; ADA: Adalimumab; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis B virus.