TREATMENT AND OUTCOMES OF RHEUMATOID ARTHRITIS PATIENTS WITH HEPATITIS B

Abstract

Background Treatment of rheumatoid arthritis (RA) patients with hepatitis B carries risk for reactivation of hepatitis B and drug-related hepatotoxicity.

Objectives We investigated the impact of treatment for RA in patients with hepatitis B.

Methods Patients enrolled in KORONA (Korean Observational Study Network for Arthritis) with 1-year follow up assessment with data on hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) status were included in the analysis. Patient characteristics (age, sex, disease duration, delay in diagnosis, alcohol intake), disease outcome measures (DAS28, fatigue, sleep, HAQ, EQ-5D, radiographic damage, surgery), medications, and adverse events were assessed. Multiple logistic regression was used to analyze the predicting factors for liver function abnormalities.

Results : A total of 871 patients were assessed. The number of HBsAg-positive and HBcAb-positive patients were 48 (5.5%) and 372 (42.7%), respectively. HBcAb-positive groups were significantly older (56.3 ± 10.8 vs 52.5 ± 9.0 in HBsAg-positive group and 51.3 ± 13.3 in negative group, p<0.01) and had longer disease duration (8.4 ± 7.7 vs 7.7 ± 6.0 in HBsAg-positive group and 7.8 ± 7.2 in negative-group, p=0.46). There was no significant difference in disease outcome measures between the groups, except for significantly increased radiographic damage in HBcAb group (79.6% vs 70.8% in HBsAg-positive group and 72.5% in negative group, p=0.048). Methotrexate and biologics use were significantly lower in HBsAg-positive group, while hydroxychloroquine, sulfasalazine, tacrolimus, and steroids use were significantly higher. HBsAg-positive group had significantly more adverse events (52.1%) compared to HBcAb-positive group (29.3%) and negative group (32.8%). HBsAg-positivity and HBcAb-positivity was not associated with significant increase in liver function abnormalities in the study population in multiple logistic regression analysis (OR (95%CI), 2.2 (0.7-7.4) and 0.8 (0.4-1.7), respectively).

Conclusions HBsAg-positive patients were more frequently treated with steroids and less with methotrexate, but there was no significant difference in disease outcome. HBsAg-positive patients had more adverse events, but it did not show significant association with developing liver function abnormality.