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Review
. 2016 Mar;3(1):25-28.
doi: 10.5152/eurjrheum.2015.150072. Epub 2015 Oct 28.

Viral hepatitis screening guideline before biological drug use in rheumatic patients

Ömer Karadağ  1 , Timuçin Kaşifoğlu  2 , Birol Özer  3 , Sabahattin Kaymakoğlu  4 , Yeşim Kuş  5 , Murat İnanç  6 , Gökhan Keser  7 , Sedat Kiraz  1
Affiliations
Review

Viral hepatitis screening guideline before biological drug use in rheumatic patients

Ömer Karadağ et al. Eur J Rheumatol. 2016 Mar.

Abstract

Biological drugs (tumor necrosis factor inhibitors, rituximab, tocilizumab, abatacept, and tofacitinib) are important treatment alternatives in rheumatology, particularly for resistant patients. However, they may cause hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation; for instance, HBV reactivation may occur in a patient who is an inactive hepatitis B surface antigen (HBsAg) carrier or who has resolved HBV infection. Therefore, the screening of patients before biological treatment and the application of a prophylactic treatment, particularly with respect to latent HBV infections, are recommended when necessary. This guideline covers pre-treatment screening and follow-up recommendations, if required, with respect to viral hepatitides in rheumatology patients who are planned to be given biological drugs. Although this guideline is prepared for biological disease-modifying antirheumatic drugs (DMARDs), it is recommended to be used also for target-oriented DMARDS and medium-high dose corticosteroids (>7.5 mg prednisolone/day equivalent). It should be considered that the reactivation risk is higher when more than one immunosuppressive drug is used.

Keywords: Viral hepatitis; biologic drugs; rheumatic patients.

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Figures

Figure 1
Figure 1
Algorithm for screening and prophylaxis of HBV in rheumatic diseases before biological drugs use HBV: hepatitis B virus; DMARDs: disease-modifying antirheumatic drugs; TNF: tumor necrosis factor; HBsAg: hepatitis B surface antigen; Anti-HBs: antibody to hepatitis B surface antigen; Anti-HBc: antibody to hepatitis B core antigen; HBeAg: hepatitis B e antigen; Anti-HBe: antibody to hepatitis B e antigen
See this image and copyright information in PMC

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