HBV infection may compromise treatment response in patients with RA
medwireNews: Chronic hepatitis B virus (HBV) infection is associated with poor response to treatment among patients with rheumatoid arthritis (RA), study results suggest.
Lie Dai and fellow researchers from Sun Yat-sen University in Guangzhou, China, observed that 53% of 32 RA patients with chronic HBV infection from their center experienced radiographic disease progression – defined as an increase in modified Sharp/van der Heijde score of at least 0.5 points – over 1 year of treatment with RA medications including methotrexate, glucocorticoids, and biologic agents.
By comparison, only 17% of 128 RA patients without HBV infection who were matched by age, sex, and baseline disease activity experienced radiographic progression at the 1-year follow-up. There was no significant difference between the two groups in the type of RA treatment used.
Patients with HBV were also less likely than those without to meet the RA therapeutic target of Disease Activity Score at 28 joints based on C-reactive protein (DAS28-CRP) below 2.6 points at 6 months, with rates of 53% versus 82%.
In a multivariate analysis, RA patients with HBV infection were more than twice as likely as those without to experience radiographic progression over 1 year (odds ratio [OR]=2.4).
Similarly, HBV infection was significantly associated with failure to achieve DAS28-CRP target, with an OR of 2.6 after accounting for treatment regimens, rising to 2.8 following additional adjustment for cumulative methotrexate dose.
In all, 47% of patients with chronic HBV and 53% of those without experienced adverse events during 1 year of RA treatment, including aminotransferase elevation, gastrointestinal discomfort, and infections. Around a third of patients with chronic HBV experienced reactivation of the virus during treatment for RA, and two patients experienced hepatitis flare.
The researchers note that antiviral treatment with entecavir or tenofovir “was suggested for all patients” with RA and chronic HBV infection, but only 44% of these patients received such treatment, “due to economic reasons.”
Taken together, these findings indicate that “HBV infection may play a deleterious role in radiographic and clinical outcomes in patients with RA,” and close attention should be paid to viral reactivation during immunosuppressive therapy, write Dai and colleagues in Arthritis Research & Therapy.
They caution, however, that their study was limited by its retrospective design and small patient numbers, and recommend that “a larger, placebo-controlled study” should be carried out to determine “[w]hether clearance of HBV would lead to a good therapeutic response in RA.”
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