慢性B型肝炎的類風濕性關節患者接受abatacept的B肝復發合併肝炎之高風險

High risk of hepatitis virus B associated hepatitis flare in rheumatoid arthritis patients with chronic hepatitis B virus infection receiving abatacept

目的：探討患有慢性B肝的類風溼性關節炎患者接受abatacept後B肝復發合併肝炎的風險。方法：採回溯性研究，篩選2013至2020年接受abatacept的類風溼性關節炎病患，納入慢性肝炎的患者，分析其是否有B肝復發合併肝炎、及復發者相關的臨床病程。結果：六位納入分析的患者，四位（66%）有B肝復發合併肝炎的狀況，其中一位死於肝衰竭。此四位病患有兩位在接受abatacept時有使用抗病毒藥，但停藥後B肝復發。結論：接受abatacept的慢性B肝的類風濕性關節炎病患B肝復發合併肝炎的風險高，這群病患需要考慮抗病毒藥的預防性使用。

Objective: To explore the hepatitis B virus (HBV) reactivation in patients with rheumatoid arthritis (RA) and chronic hepatitis B (CHB) receiving abatacept.Methods: A retrospective analysis was performed, patients with CHB and RA treated with abatacept from was enrolled from 2013 to 2020 at National Taiwan University. Results: Four of six (66%) RA patients with CHB developed HBV reactivation in a median time of 7 months (range: 3.5-12.2). All four patients had hepatitis flare, and one patient developed hepatic decompensation and died. Two of the four patients without antiviral prophylaxis (50%) had hepatitis flare, while two patients with antiviral treatment at abatacept initiation experienced hepatitis flare after antiviral medication discontinuation. Conclusion: High rates of HBV reactivation and hepatitis flare noted in patients with RA and CHB. Anti-viral prophylaxis is strongly recommended.