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09 Nov 2017
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Short-course tocilizumab treatment may induce HBV reactivation in RA

25 Aug 2017

Treatment with three consecutive doses of tocilizumab (TCZ) in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) appears to increase the risk of hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients with chronic HBV infection, although the patients remain asymptomatic and have a benign outcome after antiviral treatment, a study has found.

The study included 63 RA patients with moderate to high disease activity, with at least one feature of poor prognosis and inadequate response to csDMARDs. Of the patients, seven had chronic HBV infection, 41 had resolved HBV infection and 15 had non-HBV infection. Three consecutive doses of intravenous TCZ were given combined with csDMARDs.

Assessments including liver function and HBV infection status were performed at baseline, weeks 4, 8 and 12.

HBV reactivation after one to three doses of TCZ occurred in three patients with chronic HBV infection and without antiviral prophylaxis. These patients were asymptomatic of hepatitis B, having normal aminotransferases. Furthermore, their HBV-DNA became undetectable after therapeutic antiviral therapy. None of the patients with resolved HBV infection developed HBV reactivation.

Aminotransferase elevation was observed in 22 percent of patients, but only two patients exhibited an elevation that was at least twofold of normal range. Of these two patients, one was treated with adefovir before TCZ for active hepatitis B and the other had resolved HBV infection, with aminotransferases returning to normal 4 weeks later.

Among patients with resolved HBV infection, 32 had positive anti-HBs (≥10 IU/L), which is a protective antibody. The anti-HBs titre from baseline decreased significantly at weeks 4 and 8 after the first dose of TCZ (p<0.05), even dropping to negative in six patients (19 percent). The anti-HBs did not return to positive in three patients during 12 to 36 weeks of follow-up.

Additional studies with larger sample sizes and fewer confounding factors are warranted to identify the exact risk of TCZ on HBV infection and the prognosis of TCZ-related HBV reactivation, researchers said.

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Most Read Articles
09 Nov 2017
Treatment with fesoterodine shows efficacy in patients with nocturnal urgency secondary to overactive bladder syndrome and low nocturnal bladder capacity with a mismatch between nocturnal urine production and bladder capacity, reports a recent study.
Pearl Toh, 4 days ago
A study finds no evidence that using pharmaceutical aids alone for smoking cessation helps improve the chances of successful quitting despite promising results in previous randomized trials and routine prescription of such drugs to help quit smoking.
01 Jan 2012
A phase III, open-label, single-centre study presents the suitability of DTaP-IPV//PRP-T booster following primary vaccination with DTaP-IPV-Hep B-PRP-T vaccine.
Elvira Manzano, 22 Nov 2017
A blood pressure (BP) reading of 130/80 mm Hg or higher is the ‘new high’ in the latest AHA/ACC* hypertension guidelines, a threshold that is tighter than the JNC 7** cutpoint of 140/90 mm Hg for stage 1 hypertension in the general population. The change will mean more patients being labelled with hypertension.