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P548 Hepatitis B virus reactivation in hepatitis B virus infected patients with inflammatory bowel disease receiving anti-tumor necrosis factor-alpha therapy

Lee J.M.*1, Lee K.-M.1, Kim H.-S.2, Ye B.D.3, Park S.J.4, Park S.H.3, Im J.P.5, Jang B.I.6, Kim D.B.1

1The Catholic University of Korea, School of Medicine, St. Vincent's Hospital, Suwon, South Korea 2Yonsei University Wonju College of Medicine, Wonju, South Korea 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea 4Yonsei University College of Medicine, Seoul, South Korea 5Seoul National University College of Medicine, Seoul, South Korea 6Yeungnam University College of Medicine, Daegu, South Korea

Background

Reactivation of hepatitis B virus (HBV) is one of the most important side effects in IBD patients with HBV infection treated with anti-TNF-alpha agents. We investigated the rate of prophylaxis and the risk of HBV reactivation in HBV infected patients with IBD receiving anti-TNF-alpha therapy.

Methods

This was a retrospective multicenter study including 14 academic teaching hospitals in Korea. IBD patients with HBV infection (HBsAg-positive) who treated with anti-TNF-alpha agents were enrolled. Medical records of patients were reviewed and data were collected using web-based case report form.

Results

A total of 61 patients (18 UC, 43 CD) were included. 70% were male and mean age at diagnosis was 34.9±12.0 years. Indications for anti-TNF-alpha therapy were steroid-dependency, refractoriness to conventional therapies, or fistulizing disease. Among 43 patients who tested serum HBV-DNA levels, 35 (81%) were positive for HBV-DNA prior to anti-TNF-alpha therapy. Only half of the patients (51%) received prophylactic anti-viral agents. During the follow-up of median 24 months, 16.4% of patients experienced HBV reactivation, of which 6 patients (60%) were taking concomitant azathioprine. Median duration of anti-TNF-alpha therapy before HBV reactivation was 9 months. HBV reactivation was managed by change or adding of anti-viral agents in 6 patients, discontinuing ant-TNF-alpha in 1 patient, and combination of both in 2 patients, achieving virological response in most patients (90%). HBV reactivation was more frequent in non-prophylaxis group than prophylaxis group (10% vs 24.1%, p=0.15). No other predictors for HBV reactivation were identified. There was no difference in the rates of IBD flare, IBD-related surgery or hospitalization between two groups.

Conclusion

HBV reactivation was not infrequent in HBsAg-positive IBD patients treated with anti-TNF-alpha agents. Prophylaxis for HBV reactivation and careful monitoring should be performed for such patients.