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A proposal for management of rheumatic disease patients with hepatitis B virus infection receiving immunosuppressive therapy

  • Review Article
  • Published:
Modern Rheumatology

Abstract

Reactivation of hepatitis B virus (HBV) and de novo HBV hepatitis in patients with rheumatic diseases given intensive and long-term immunosuppressive therapy with or without biological disease-modifying antirheumatic drugs is of great concern, especially in regions where the virus is endemic, including Japan. To ascertain a better benefit–risk balance for immunosuppressive therapy for patients with rheumatic diseases, the Japan College of Rheumatology developed this proposal. All patients with rheumatic diseases commencing immunosuppressive therapy should be screened for hepatitis B surface antigen (HBsAg); those who are negative for HBsAg should be screened for hepatitis B core antibody (HBcAb) and hepatitis B surface antibody (HBsAb) as well. HBV carriers and serum HBV DNA positive patients with resolved infection should receive nucleoside analog as soon as possible, prior to commencing immunosuppressive therapy. For serum HBV DNA negative patients with resolved infection, careful monthly monitoring using serum levels of aspartate and alanine aminotransferases and HBV DNA is recommended during and at least 12 months after withdrawal of immunosuppressive therapy. If serum HBV DNA becomes positive, patients should receive nucleoside analog treatment as soon as possible, while ongoing immunosuppressive therapy should be continued to avoid severe or fulminant hepatitis development. To facilitate proper management of patients with HBV infection, collaboration between rheumatologists and hepatologists is strongly encouraged.

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Acknowledgments

This work was supported by a Health and Labour Sciences Research grant (H23-meneki-sitei-016 to M. Harigai and N. Miyasaka), a grant-in-aid for scientific research from the Japan Society for the Promotion of Science (no. 23590171 to M. Harigai and N. Miyasaka), and a grant from the Japanese Ministry of Education, Global Center of Excellence (GCOE) Program, International Research Center for Molecular Science in Tooth and Bone Diseases (to N. Miyasaka). This work was supported by a Health and Labour Sciences Research grant, Research on Hepatitis and BSE (H-23-kanen-ippan-002 and H24-kanen-ippan-004 to S. Mochida), and Research on Measures for Intractable Diseases (H-23-nanchi-ippann-025 to S. Mochida) from the Ministry of Health, Labour, and Welfare of Japan.

Conflict of interest

M.H. has received research grants, speaking fees or honoraria from Abbott, Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Santen Pharmaceutical, Takeda Pharmaceutical, UCB Japan, and Pfizer and received consultant fees from Abbott, Bristol Myers Squibb, Chugai Pharmaceutical, and Janssen Pharmaceutical. S.M. has received research grants, speaking fees or honoraria from Ajinomoto Pharmaceuticals Co., Ltd., Astellas Pharma Inc., Bayer Yakuhin Ltd., Bristol Myers Squibb, Chugai Pharmaceutical, Dainippon Sumitomo Pharma, Eisai Pharmaceutical, GlaxoSmithKline K.K., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Otsuka Pharmaceutical Co., Ltd., and Toray Medical Co., Ltd. T.M. has received research grants from Abbott, Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical, Astellas Pharmaceutical, and Pfizer and received lecture fees from Chugai Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, and Takeda Pharmaceutical. T.K. has received consultancies, speaking fees, and honoraria from Abbott, Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical, Daiichi Sankyo Pharmaceutical, Eisai Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Santen Pharmaceutical, Takeda Pharmaceutical, Teijin Pharmaceutical, Pfizer, and Otsuka Pharmaceutical. N.M. has received research grants from Abbott, Astellas Pharmaceutical, Banyu Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo Pharmaceutical, Eisai Pharmaceutical, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical, and Teijin Pharmaceutical.

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Authors and Affiliations

  1. Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Masayoshi Harigai

  2. Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Masayoshi Harigai & Nobuyuki Miyasaka

  3. Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan

    Satoshi Mochida

  4. Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan

    Toshihide Mimura

  5. NTT Sapporo Medical Center, Hokkaido, Japan

    Takao Koike

  6. Global Center of Excellence Program, International Research Center for Molecular Science in Tooth and Bone Diseases, Tokyo, Japan

    Nobuyuki Miyasaka

Authors
  1. Masayoshi Harigai
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  2. Satoshi Mochida
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  3. Toshihide Mimura
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  4. Takao Koike
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  5. Nobuyuki Miyasaka
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Correspondence to Masayoshi Harigai.

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Harigai, M., Mochida, S., Mimura, T. et al. A proposal for management of rheumatic disease patients with hepatitis B virus infection receiving immunosuppressive therapy. Mod Rheumatol (2012). https://doi.org/10.1007/s10165-012-0810-y

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