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bioRxiv · 10.1101/661850

Risk factors associated with loss of hepatitis B virus surface antibody in patients with HBV surface-antigen negative/surface antibody positive serostatus receiving biologic DMARDs to treat rheumatic diseases - a nested case-control study

Hung, M.-H.·Tien, Y.-C.·Chiu, Y.-M.
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Abstract

ObjectivesTo elucidate risk factors for loss of hepatitis B virus (HBV) surface antibody (anti-HBs) in patients with rheumatic diseases and HBV surface-antigen negative/anti-HBs positive (HBsAg-/anti-HBs+) serostatus during biologic disease-modifying anti-rheumatic drug (DMARD) treatment.\n\nMethodsThis nested case-control study prospectively enrolled patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis/psoriasis, and juvenile idiopathic arthritis, who were treated with biologic DMARDs from January 2013 to September 2017. The analytic sample included patients with HBsAg-/anti-HBs+ serostatus. Anti-HBs titers were monitored, and cases defined as anti-HBs <10 mIU/mL during follow-up. Cases were matched one-to-all with controls with anti-HBs [&ge;]10 mIU/mL on the same event date and equivalent durations of biologic DMARDs treatment. Between-group characteristics were compared and risk factors for anti-HBs loss elucidated by conditional logistic regression analyses.\n\nResultsAmong 189 enrolled patients, 15 cases were matched with 211 controls. Risk factors associated with anti-HBs loss in multivariate analysis were low baseline anti-HBs titer (adjusted risk ratio = 0.96, 95% CI 0.93-0.99) and chronic kidney disease (adjusted risk ratio = 26.25, 95% CI 1.85-372.35). All cases had baseline anti-HBs titer <100 mIU/mL, and none developed HBV reactivation upon losing anti-HBs.\n\nConclusionsIn addition to low baseline anti-HBs titer, chronic kidney disease is also an independent risk factors associated with loss of anti-HBs in patients with HBsAg-/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases.\n\nSignificanceGiven that loss of anti-HBs precedes HBV reactivation and that the use of biologic DMARDs is increasingly widespread nowadays, understanding those who are at risk of loss of anti-HBs is an important and practical clinical issue.\n\nInnovationIn addition to low baseline anti-HBs titer, chronic kidney disease is also an independent risk factors associated with loss of anti-HBs in patients with HBsAg-/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases.

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Hung, M.-H., Tien, Y.-C., Chiu, Y.-M.. 2019-06-05. Risk factors associated with loss of hepatitis B virus surface antibody in patients with HBV surface-antigen negative/surface antibody positive serostatus receiving biologic DMARDs to treat rheumatic diseases - a nested case-control study. https://doi.org/10.1101/661850

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