Tofacitinib may promote HBV reactivation in certain RA patients

24 Sep 2021
Tofacitinib may promote HBV reactivation in certain RA patients

Use of tofacitinib for rheumatoid arthritis (RA) may lead to reactivation of hepatitis B virus (HBV), especially among hepatitis B surface antigen-positive (HBsAg+) and HBsAg-negative/hepatitis B core antibody-positive (HBsAg–/HBcAb+) patients, according to a study from Taiwan.

The retrospective study included 98 RA patients receiving treatment with tofacitinib for at least 3 months. All patients were followed up every 3 to 6 months to have their serum HBV DNA levels and serum alanine aminotransferase assessed for HBV reactivation.

Of the patients, eight were HBsAg+ (8.1 percent) and 64 were HBsAg−/HBcAb+ (65.3 percent). In the HBsAg+ RA group, two patients were administered antiviral prophylaxis, and none of them had HBV reactivation or hepatitis flare-up.

HBV reactivation occurred in two out of six patients in the HBsAg+ RA group who did not receive antiviral prophylaxis (33.3 percent). In the HBsAg−/HBcAb+ RA group, two patients had HBV reactivation (3.1 percent).

The corresponding incidence rate of HBV reactivation in the HBsAg+ RA group was 153.8 per 1,000 person-years overall and 250 per 1,000 person-years after excluding patients who had received antiviral prophylaxis. In the HBsAg−/HBcAb+ RA group, the incidence rate was 11.2 per 1,000 person-years.

The present data suggest that HBV reactivation occurrence following tofacitinib use is especially high in the HBsAg+ RA group, and reactivation can be avoided by antiviral prophylaxis. On the other hand, the risk of reactivation is low in the HBsAg−/HBcAb+ RA group, although close monitoring of HBV DNA and alanine aminotransferase is still recommended.

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