Prophylaxis and therapy of HBV infection in 20 patients treated with disease modifying antirheumatic drugs or with biological agents for rheumatic diseases.

OBJECT To evaluate the safety and tolerability of lamivudine in patients with HBV infection needing immunosuppressive treatment for rheumatic diseases. PATIENTS AND METHODS Twenty patients with rheumatic diseases planned to receive immunosuppressive DMARDs or biological agents were screened for HBV markers. In all active carriers antiviral treatment was recommended. Inactive carriers (HBsAg positive, aminotrasferase and viremia persistently normal) were divided into two risk categories according to the type and the degree of immunosuppression, and antiviral prophylaxis was started only in patients of the high risk category. Antiviral treatment was recommended also in potential occult carriers (HBsAg negative, HBcAb positive) treated with rituximab. In twenty patients antiviral treatment was started: 1 was a potential occult carrier planned to receive rituximab; 9 were inactive carriers, in which prophylactic therapy was needed for a high risk of HBV reactivation (in 3, for the use of TNF blocking agents); 10 were treated for active viral replication. Prophylaxis and therapy were performed with lamivudine. In three patients adefovir was associated. RESULTS Antiviral drugs were well tolerated. In all cases, immunosuppressive treatment was given for the planned duration of therapy, with good results on the rheumatic diseases. Median duration of antiviral treatment was 19 months (for a total of 386 month/person). No cases of viral reactivation were observed. CONCLUSION Our experience demonstrates the feasibility of a prophylaxis and therapy of HBV infection in patients with rheumatic diseases. This approach reduces the risk of viral reactivation and allows the choice of the optimal immunosuppressive treatment in rheumatic patients.

[1]  R. Bruno,et al.  Prophylaxis and treatment of hepatitis B in immunocompromised patients. , 2007, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[2]  C. Roux,et al.  Safety of anti-TNF-alpha therapy in rheumatoid arthritis and spondylarthropathies with concurrent B or C chronic hepatitis. , 2006, Rheumatology.

[3]  D. Vassilopoulos,et al.  Hepatitis B virus (HBV) reactivation with immunosuppressive therapy in rheumatic diseases: assessment and preventive strategies , 2006, Annals of the rheumatic diseases.

[4]  B. Coiffier.  Hepatitis B Virus Reactivation in Patients Receiving Chemotherapy for Cancer Treatment: Role of Lamivudine Prophylaxis , 2006, Cancer investigation.

[5]  F. Schena,et al.  Improvement of renal function and disappearance of hepatitis B virus DNA in a patient with rheumatoid arthritis and renal amyloidosis following treatment with infliximab. , 2005, Arthritis and rheumatism.

[6]  D. Bettinger,et al.  Reactivation of a latent precore mutant hepatitis B virus related chronic hepatitis during infliximab treatment for severe spondyloarthropathy , 2005, Annals of the rheumatic diseases.

[7]  F. T. Veloso,et al.  Reactive hepatitis in a patient with Crohn's disease successfully treated with infliximab: does tumor necrosis factor alpha play a role in reactive hepatitis? , 2005, Inflammatory bowel diseases.

[8]  K. Chayama,et al.  Infliximab Therapy for Crohn’s Disease in a Patient with Chronic Hepatitis B , 2005, Digestive Diseases and Sciences.

[9]  D. Vassilopoulos,et al.  Safety of antitumour necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B, and HIV infection , 2004, Annals of the rheumatic diseases.

[10]  María del Valle García-Sánchez,et al.  Infliximab therapy in a patient with Crohn's disease and chronic hepatitis B virus infection. , 2004, Inflammatory bowel diseases.

[11]  P. Angus,et al.  Hepatic failure due to fibrosing cholestatic hepatitis in a patient with pre-surface mutant hepatitis B virus and mixed connective tissue disease treated with prednisolone and chloroquine. , 2004, Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology.

[12]  F. González‐Huix,et al.  Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis , 2004, Gut.

[13]  M. Kurosaki,et al.  Fulminant hepatitis in an asymptomatic chronic carrier of hepatitis B virus mutant after withdrawal of low-dose methotrexate therapy for rheumatoid arthritis. , 2004, Clinical and experimental rheumatology.

[14]  J. Pawlotsky,et al.  Infliximab therapy for rheumatic diseases in patients with chronic hepatitis B or C. , 2004, The Journal of rheumatology.

[15]  S. Hadziyannis,et al.  Review article: current management of chronic hepatitis B. , 2004, Alimentary pharmacology & therapeutics.

[16]  G. Rossi,et al.  Frequency of hepatitis B virus mutant in asymptomatic hepatitis B virus carriers receiving prophylactic lamivudine during chemotherapy for hematologic malignancies. , 2004, The hematology journal : the official journal of the European Haematology Association.

[17]  D. Fong,et al.  Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy. , 2003, Gastroenterology.

[18]  M. Michel,et al.  Fulminant hepatitis after infliximab in a patient with hepatitis B virus treated for an adult onset still's disease. , 2003, The Journal of rheumatology.

[19]  L. Punzi,et al.  Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate , 2003, Annals of the rheumatic diseases.

[20]  M. Manns,et al.  Treatment of hepatitis B in special patient groups: hemodialysis, heart and renal transplant, fulminant hepatitis, hepatitis B virus reactivation. , 2003, Journal of hepatology.

[21]  M. Boers,et al.  Keeping up appearances , 2002, Annals of the rheumatic diseases.

[22]  M. S. Longhi,et al.  Reactivation of replication of hepatitis B and C viruses after immunosuppressive therapy: an unresolved issue. , 2002, The Lancet. Oncology.

[23]  L. Biancone,et al.  Immunomodulatory drugs in Crohn's disease patients with hepatitis B or C virus infection. , 2002, Gastroenterology.

[24]  G. Rossi,et al.  Primary prophylaxis with lamivudine of hepatitis B virus reactivation in chronic HbsAg carriers with lymphoid malignancies treated with chemotherapy , 2001, British journal of haematology.

[25]  R. Perrillo.  Acute flares in chronic hepatitis B: the natural and unnatural history of an immunologically mediated liver disease. , 2001, Gastroenterology.

[26]  A. Murasawa,et al.  Development of fulminant hepatitis B (precore variant mutant type) after the discontinuation of low-dose methotrexate therapy in a rheumatoid arthritis patient. , 2001, Arthritis and rheumatism.

[27]  W. Yeo,et al.  Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: A prospective study of 626 patients with identification of risk factors , 2000, Journal of medical virology.

[28]  M. Yuen,et al.  Safety of disease modifying anti-rheumatic agents in rheumatoid arthritis patients with chronic viral hepatitis. , 2000, Clinical and experimental rheumatology.

[29]  Damiani,et al.  Lamivudine allows completion of chemotherapy in lymphoma patients with hepatitis B reactivation , 2000, British journal of haematology.

[30]  M. Scheurlen,et al.  Prevention of hepatitis B flare-up during chemotherapy using lamivudine: case report and review of the literature , 1999, Annals of Hematology.

[31]  G. McDonald,et al.  Hepatitis viruses and hematopoietic cell transplantation: A guide to patient and donor management. , 1999, Blood.

[32]  P. Davis.  Severe hepatitis linked to B virus infection after withdrawal of low dose methotrexate therapy. , 1998 .

[33]  J. Narváez,et al.  Severe hepatitis linked to B virus infection after withdrawal of low dose methotrexate therapy. , 1998, The Journal of rheumatology.

[34]  T. Motokura,et al.  Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies: Survey in Japan, 1987‐1991 , 1996 .

[35]  M. Sherman,et al.  Fulminant hepatitis as a consequence of reactivation of hepatitis B virus infection after discontinuation of low-dose methotrexate therapy. , 1990, Annals of internal medicine.

[36]  A. Lok,et al.  Fatal reactivation of chronic hepatitis B virus infection following withdrawal of chemotherapy in lymphoma patients. , 1989, The Quarterly journal of medicine.