Risk of alanine aminotransferase flare in patients with previous hepatitis B virus exposure on biological modifier therapies—A population‐based study

Autor: Jacky C. L. Ho, Joyce W. Y. Mak, Terry C. F. Yip, Hong Man Lam, Tsz Yan Cheng, Tsz On Lam, Lai Shan Tam, Man Fai Law, Carmen K. M. Cheung, Siew C. Ng, Vincent W. S. Wong, Grace L. H. Wong
Rok vydání: 2022
Předmět:
Zdroj: Liver International. 43:588-598
ISSN: 1478-3231
1478-3223
Popis: It is uncertain whether biological therapies would increase the risk of hepatitis among patients with past hepatitis B virus (HBV) infection. This study aimed to evaluate the risk of alanine aminotransferase (ALT) flare in patients with past HBV infection while using biological therapies.Patients who received biological therapies for ≥3 months from 2000 to 2019 were identified from a population-based database in Hong Kong. Patients with past HBV infection were compared with a control group without prior HBV exposure. The primary endpoint was development of ALT flare within 5 years of starting biological therapies, defined as ALT 80 IU/L.There were 2471 and 2394 patients with and without past HBV infection respectively. There was a non-significant increase in risk of ALT flare among the HBV-exposed group (27.6% vs. 23.7%, p = .055). In multivariable analysis, using prednisolone-equivalent dose of20 mg daily, male sex and concomitant immunosuppressants were risk factors for ALT flare. The risk of ALT flare was significantly higher with anti-CD20 when compared to other biological agents (36.1% vs. 14.5%, p .01), but was not significantly different among anti-tumour necrosis factor, anti-cytokine, Janus kinase inhibitors and T cell/B cell inhibitors or anti-integrin (15.2% vs. 14.6% vs. 11.7% vs. 11.1%, p = .82). Among patients with documented hepatitis B surface antigen seroreversion, 96% were on anti-CD20.Our study further supports the current suggestion of prophylactic anti-viral before starting anti-CD20 in HBV-exposed patients. While other biological therapies appear to have a lower risk for ALT flare, this result needs further confirmation.
Databáze: OpenAIRE
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