The Relationship Between TNF-α Inhibitor Potency and HBV Reactivation in Patients With Rheumatic Disorders

Area of Science:

• Rheumatology
• Hepatology
• Immunology

Background:

• Rheumatologic patients treated with TNF-α inhibitors are at risk of hepatitis B virus (HBV) reactivation, particularly those positive for hepatitis B surface antigen (HBsAg) or core antibody (HBcAb).
• Current guidelines suggest risk stratification based on TNF-α inhibitor potency, but its specific impact on HBV reactivation remains unclear.

Purpose of the Study:

• To investigate the influence of TNF-α inhibitor potency on the risk of HBV reactivation in patients with rheumatic diseases.
• To compare HBV reactivation rates across different TNF-α inhibitor potencies and patient HBV serostatuses.

Main Methods:

• A cohort study identified 711 new TNF-α inhibitor users with rheumatic diseases from January 2008 to June 2023.
• A Cox proportional hazards model was employed to assess factors associated with HBV reactivation, analyzing data from HBsAg+ patients with and without antiviral prophylaxis, and HBsAg-/HBcAb+ patients without prophylaxis.

Main Results:

• HBsAg+ patients without antiviral prophylaxis exhibited the highest HBV reactivation rate (104.1 per 1000 person-years).
• High-potency TNF-α inhibitors significantly increased HBV reactivation risk in HBsAg+ patients without prophylaxis (aHR 3.24). Adalimumab and golimumab showed higher risks than etanercept.
• For HBsAg-/HBcAb+ patients, TNF-α inhibitor potency did not significantly affect reactivation risk; age over 65 was the primary risk factor (aHR 3.37).

Conclusions:

• High-potency TNF-α inhibitors are associated with a significantly increased risk of HBV reactivation in HBsAg+ rheumatologic patients.
• HBsAg-/HBcAb+ patients demonstrate a consistently low risk of HBV reactivation across all TNF-α inhibitors, with age being a key risk factor.