Su J, et al. - Experts evaluated the risk of reactivation of hepatitis B virus (HBV) and assess the efficacy of antiviral prophylaxis (AVP) in subjects with different status of HBV infection undergoing antirheumatic therapies. They noted limited evidence supporting the efficacy of AVP for preventing reactivation of HBV in patients undergoing antirheumatic therapy. The patient HBV status and antiviral regimens led to varied effectiveness. AVP could be more beneficial in rheumatic HBV carriers. Lamivudine appeared inferior when compared to other AVP.

Methods

• For randomized controlled trials (RCTs), quasi-RCTs, non-RCTs, cohort studies, or case series studies examining reactivation of HBV in patients undergoing antirheumatic therapy with or without AVP, authors searched Cochrane Library, Medline, and EMBASE.
• The HBV reactivation rate (HRR) and its 95% confidence interval (CI) was estimated among different patient groups (indirect comparison).
• They also calculated rate ratio (RR), rate difference (RD) with their 95% CIs, and the number needed to treat (NNT) of AVP (direct comparison).

Results

• As per data, 53 case series studies with 2,162 patients were included.
• Findings suggested the RD of AVP to be - 0.13 (95% CI - 0.21 to - 0.05) for all patients, - 0.16 (95% CI - 0.26 to - 0.06) for rheumatic patients with chronic HBV infection, but for patients with other status of HBV infection, it was not statistically significant.
• Researchers noted that lamivudine (RD - 0.10, 95% CI - 0.25 to 0.05) was less effective vs other prophylactic antiviral drugs (RD - 0.31, 95% CI - 0.52 to - 0.11).
• By HBV status and treatment, the HHR varied from 55 to 5%.