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World J Hepatol. Mar 27, 2015; 7(3): 344-361
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.344
Risk of hepatitis B virus reactivation in rheumatoid arthritis patients undergoing biologic treatment: Extending perspective from old to newer drugs
Francesca De Nard, Monica Todoerti, Vittorio Grosso, Sara Monti, Silvia Breda, Silvia Rossi, Carlomaurizio Montecucco, Roberto Caporali
Francesca De Nard, Monica Todoerti, Vittorio Grosso, Sara Monti, Silvia Breda, Silvia Rossi, Carlomaurizio Montecucco, Roberto Caporali, IRCCS Policlinico San Matteo Foundation, Chair and Division of Rheumatology, University of Pavia, 27100 Pavia, Italy
Author contributions: Montecucco C revised the paper; De Nard F, Grosso V, Monti S, Breda S and Rossi S performed research; De Nard F and Grosso V analyzed the data; De Nard F, Todoerti M and Caporali R wrote the paper.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesca De Nard, MD, IRCCS Policlinico San Matteo Foundation, Chair and Division of Rheumatology, University of Pavia, piazzale Golgi 2, 27100 Pavia, Italy. francesca.denard01@ateneopv.it
Telephone: +39-38-2503171 Fax: +39-38-2503171
Received: September 9, 2014
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: November 25, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015
Processing time: 203 Days and 3.7 Hours
Abstract

Hepatitis B virus (HBV) reactivation in rheumatoid arthritis (RA) patients undergoing biological therapy is not infrequent. This condition can occur in patients with chronic hepatitis B as well as in patients with resolved HBV infection. Current recommendations are mainly focused on prevention and management strategies of viral reactivation under tumor necrosis factor-α inhibitors or chimeric monoclonal antibody rituximab. In recent years, growing data concerning HBV reactivation in RA patients treated with newer biological drugs like tocilizumab and abatacept have cumulated. In this review, epidemiology, pathogenesis and natural history of HBV infection have been revised first, mainly focusing on the role that specific therapeutic targets of current biotechnological drugs play in HBV pathobiology; finally we have summarized current evidences from scientific literature, including either observational studies and case reports as well, concerning HBV reactivation under different classes of biological drugs in RA patients. Taking all these evidences into account, some practical guidelines for screening, vaccination, prophylaxis and treatment of HBV reactivation have been proposed.

Keywords: Rheumatoid arthritis; Hepatitis B virus; Biologics; Anti-TNF; Rituximab; Tocilizumab; Abatacept

Core tip: Hepatitis B virus (HBV) infection represents a major issue in patients with rheumatoid arthritis (RA) undergoing biological disease-modifying anti-rheumatic drugs (bDMARDs). While several observational studies and trials deal with the risk of HBV reactivation under anti-TNF agents, there is limited experience with newer drugs as tocilizumab (TCZ) and abatacept (ABA). In this paper, literature concerning the risk of HBV reactivation in RA patients undergoing different classes of bDMARDs, including ABA and TCZ, has been revised. Finally, some evidence-based practical suggestions for the management of this condition are proposed.