Risk of Hepatitis B Virus Reactivation in Patients With Inflammatory Arthritis Receiving Disease‐Modifying Antirheumatic Drugs: A Systematic Review and Meta‐Analysis

Objectives To assess 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. Methods We conducted a systematic review and meta-analysis. 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). Four reviewers independently extracted study data and assessed study quality with the Newcastle-Ottawa scales. To determine the pooled hepatitis B reactivation rate, the variances of the raw proportions were stabilized using a Freeman-Tukey-type arcsine square root transformation, using a random-effects model. Results Twenty-five studies met the inclusion criteria. The overall pooled rate of hepatitis B reactivation was 1.6% (95% CI, 0.8-2.6%) in patients with resolved hepatitis B. 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%). We also found the reactivation rate was lower 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%). Conclusion We found the hepatitis B reactivation rate in inflammatory arthritis patients receiving DMARDs was low in resolved patients and moderate in chronic HBV infection patients. Further, lower rates were observed in chronic HBV infection patients using antiviral prophylaxis. This article is protected by copyright. All rights reserved.