Aslı KELEŞ ÖNAL, Selda SARIKAYA, Şenay ÖZDOLAP ÇOBAN, Ali Erdem BAKİ, Fürüzan KÖKTÜRK

Biyolojik DMARD Kullanan Hastalarda Kronik Hepatit B Enfeksiyonu ve Okkült Hepatit B Sıklığı ve Tedavi Yönetimi

Amaç: Biyolojik hastalık modifiye edici ilaç (bDMARDs) kullanan hastaların (romatoid artrit, ankilozan spondilit ve psöriatik artrit) Hepatit B virüs (HBV) reaktivasyonu, kronik ve okkült HBV varlığını araştırmayı hedefledik. Gereç ve Yöntemler: Zonguldak Bülent Ecevit Üniversitesi Sağlık Uygulama Araştırma Hastanesi Fiziksel Tıp ve Rehabilitasyon kliniğinde takip edilen ve biyolojik DMARDs (infliksimab, adalimumab, etanercept, golimumab, sertolizumab, tofasitinib, sekukinumab, tosilizumab, ustekinumab) kullanan hastaların dosyalarında yer alan verileri retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, tanıları (romatoid artrit, ankilozan spondilit ve psöriatik artrit), kullanmakta olduğu ilaçlar, kullanım süreleri, Hepatit B antijen ve antikorları (HBsAg, anti-HBs ve anti-HBc IgG) ve HBV için ilaç kullanmakta olan hastalar kaydedildi. Bulgular: Çalışmaya 138 hasta dahil edildi. Hastaların 64’ü (%46,4) kadın ve 74’ü (%53,6) erkekti. Ortalama yaşları 47,7±11,9 yıl olarak hesaplandı. Olguların dördünde (%2,9) HBsAg 47 (%34,8)’sinde anti-HBc IgG ve 63 (%45,6)’ünde anti-HBs pozitifliği vardı. Hastaların 32 (%23,2)’si antiviral tedavi almaktaydı. Anti HBc-Ig G(+) olan 15 (%10,8) olgu antiviral tedavisizdi ve üç aylık HBV DNA izlemleri ile takip edilmekteydi. Toplam 16 (%11,5) olgu Hepatit B’ye karşı aşılıydı. Sonuç: Çalışma sonucunda bDMARD kullanan kronik ve okkült HBV yönünden 47 olgunun ortalama beş yıllık tedavi ve klinik izleminde HBV reaktivasyonu görülmedi. Biyolojik DMARDs kullananlarda sıkı takip ve uygun protokolle HBV reaktivasyonu gibi korkulan bir komplikasyon gelişmeyebilir.

The Frequency of Chronic and Occult Hepatitis B Infection in the Patients Receiving Biological DMARD Therapy and Treatment Management

Aim: We aimed to investigate the presence of hepatitis B virus (HBV) reactivation, chronic and occult HBV in patients who are followed in the Physical Medicine and Rehabilitation Clinic of Zonguldak Bülent Ecevit University Health Practice Research Hospital and using biological disease modifying drugs (bDMARDs). Material and Methods: The data files of the patients with ongoing biological disease-modifying antirheumatic drug (bDMARD) therapy that was followed by the Physical Medicine and Rehabilitation Clinic were analyzed retrospectively. Patient data such as age, gender, diagnosis, medication and its duration, Hepatitis B antigens and antibodies (HBsAg, anti-HBs and anti-HBc IgG), and antiviral HBV treatments were recorded. Results: The study included 138 patients comprising 64 (46.4%) females and 74 (53.6%) males. The mean age was 47.7±11.9 years. HBsAg, anti-HBc IgG, and anti-HBs positivity were detected in 4 (2.9%), 47 (34.8%), and 63 (45.6%) patients in our outpatient clinic, respectively. Thirty-two (23.2%) of the patients were receiving antiviral treatment. Close HBV DNA monitoring was performed for 3 months in 15 patients with (+) anti-HBc IgG, these patients were not followed by antiviral treatment. Totally 16 patients were vaccinated against Hepatitis B. Conclusion: As a consequence of the study, no HBV reactivation was encountered in the clinical follow-up of 47 patients with an ongoing medication of meanly 5 years for chronic and occult HBV. We concluded that the development of a feared complication such as HBV reactivation can be prevented in patients using bDMARDs with strict follow-up and appropriate protocol

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