遵行風濕病醫學會免疫風濕病患接受生物製劑治療B型肝炎篩檢與防治共識建議可降低風濕病患者之B型肝炎再活化率：地區醫學中心之研究

The Taiwan Rheumatology Association Consensus Recommendations for hepatitis B virus screening contributes to lower mortality from hepatitis B reactivation in rheumatic patients: a local medical center study

目的：評估自「2012年風濕病醫學會免疫風濕病患接受生物製劑治療B型肝炎篩檢與防治共識建議」發布後，本院風濕疾病患者使用biological originator disease-modifying antirheumatic drugs（boDMARDs）或targeted synthetic disease-modifying antirheumatic drugs（tsDMARDs）之B型肝炎篩檢率及B型肝炎再活化（reactivation）事件是否有改善。方法：統計自2006年1月起至2015年12月止，本院有215位類風溼性關節炎、僵直性脊椎炎或乾癬性關節炎患者使用boDMARDs，包括了etanercept, adalimumab, golimumab, tocilizumab, rituximab, abatacept或是使用tsDMARD tofacitinib，計算其B型肝炎篩檢率以及B型肝炎再活化之事件發生率。結果：經過篩選，共207位病患納入此研究。類風濕性關節炎患者之B型肝炎表面抗原篩檢率由原本的21.5%提升至77.8%；然而僵直性脊椎炎及乾癬性關節炎患者之B型肝炎表面抗原篩檢率並無顯著差異。B型肝炎再活化之事件／病患－－年發生率，在經過遵行防治共識建議後由0.125降至0.056，其中，死亡率由25%降至0%。結論：由於台灣是B型肝炎高盛行率之國家，因此B型肝炎防治是非常重要的衛生議題。經由此次研究統計可觀察到在經由遵行「2012年風濕病醫學會免疫風濕病患接受生物製劑治療B型肝炎篩檢與防治共識建議」之後，病患的B型肝炎篩檢率提高且B型肝炎再活化之事件發生率及死亡率降低。建議應謹遵其行。

Objectives: Biologic disease-modifying antirheumatic drugs and targeted synthetic disease-modifying antirheumatic drugs are widely used for rheumatic diseases. However, reactivation of infectious diseases such as hepatitis B virus (HBV) may be exacerbated after this treatment. The aim of the study was to investigate the HBV screening rate, HBV reactivation events and the impact of the consensus recommendations from the Taiwan Rheumatology Association. Methods: We retrospectively enrolled 207 patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA) who received biological original disease-modifying antirheumatic drugs (boDMARDs) including etanercept, adalimumab, golimumab, tocilizumab, rituximab and abatacept, and the targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) tofacitinib at Tri-Service Medical Center from January 2006 to December 2015, and analyzed the HBV screening rate and HBV reactivation events. Results: The HBsAg screening rate increased from 21.5% to 77.8% after adopting the consensus recommendations. The RA patients who received etanercept and adalimumab had a higher HBsAg screening rate after January 1, 2013 (p<0.05), and those receiving etanercept had a higher anti-HBc IgG screening rate after January 1, 2013 (p=0.002). However, there was no significant difference in HBV screening rate between the patients with AS and PsA. A higher HBV screening rate was observed in the other newly emerging boDMARDs/tsDMARDs (golimumab, tocilizumab, rituximab, abatacept and tofacitinib). The number of HBV reactivation events per patient per year before and after adopting the consensus recommendations were 0.125 and 0.056, respectively. The mortality rate also decreased significantly from 25% to 0%. Conclusion: Preventing and monitoring HBV reactivation in rheumatic patients who receive boDMARDs/tsDMARD is a crucial issue in Taiwan. We recommend that the consensus recommendations from the Taiwan Rheumatology Association should be adopted to reduce the occurrence and mortality rate caused by HBV reactivation.