Lin TC, et al. – This meta–analysis was conducted to evaluate hepatitis B (HBV) reactivation rates in patients with resolved or chronic HBV infection, receiving disease modifying anti–rheumatic drugs (DMARDs) and with or without antiviral prophylaxis. It was reported that the hepatitis B reactivation rate in inflammatory arthritis patients receiving DMARDs was low in resolved patients and moderate in chronic HBV infection patients. In chronic HBV infection patients using antiviral prophylaxis, further lower rates were observed.

Methods

• Electronic searches were conducted in Pubmed, Medline and EMBASE using OVID through 12/31/2015.
• A search strategy was developed for each database using the following inclusion criteria: participants (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, resolved, or chronic HBV infection), interventions (TNF inhibitors, non–TNF biologic or non–biologic DMARDs), and outcomes (hepatitis B reactivation).
• 4 reviewers independently extracted study data and evaluated study quality with the Newcastle–Ottawa scales.
• With a Freeman–Tukey–type arcsine square root transformation, the variances of the raw proportions were stabilized to analyze the pooled hepatitis B reactivation rate.

Results

• 25 studies met the inclusion criteria.
• In patients with resolved hepatitis B, the overall pooled rate of hepatitis B reactivation was 1.6% (95% CI, 0.8–2.6%).
• Similar rates were observed in resolved patients on TNF inhibitors (1.4%, 95% CI, 0.5–2.6%), non–TNF biologics (6.1%, 95% CI, 0.0–16.6%) and non–biologic DMARDs (1.7%, 95% CI, 0.2–4.2%).
• Lower reactivation rate was found in chronic HBV infection patients who received antiviral prophylaxis (9.0%, 95% CI, 4.1–15.5%), than those who did not (14.6%, 95% CI, 4.3–29.0%).