Biyolojik ve Hedefe Yönelik Sentetik Hastalık Modifiye Edici Antiromatizmal İlaçlarla Tedavi Edilen Romatizmal Hastalarda Hepatit B ve C virüs Seroprevalansının ve Antiviral Profilaksi Oranlarının İncelenmesi: Orta Anadolu’daki Üçüncü Basamak Bir Merkezden Sonuçlar

Year 2024, , 88 - 93, 29.02.2024

Hüseyin Kaplan , Gizem Cengiz , Senem Şaş , Hasan Kara

https://doi.org/10.54005/geneltip.1362307

Abstract

Amaç: Biyolojik ve hedefe yönelik sentetik hastalık modifiye edici antiromatizmal ilaçlar (DMARD) ile tedavi edilen romatizmal hastalarda hepatit B virüsü (HBV) ve hepatit C virüsü (HCV)’nün epidemiyolojik özelliklerini değerlendirmek.
Gereç ve Yöntem: Bu kesitsel çalışma Eylül 2021 ile Nisan 2022 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Romatoloji Polikliniği'nde gerçekleştirildi ve 200 hasta [113'ü aksiyal spondiloartrit (akSpA), 18'i psöriyatik artrit (PsA) ve 69'u romatoid artrit (RA)]) dahil edildi. Hastaların demografik ve klinik özellikleri, tedavi detayları ve viral hepatit serolojileri kaydedildi. Biyolojik ve/veya hedefe yönelik sentetik DMARD (b/tsDMARD) almayanlar çalışmadan dışlandı.
Bulgular: Hastaların medyan yaşı 47 (39-58) yıl, medyan hastalık süresi ise 10 (7-15) yıldı. 117'si (%58,5) kadın, 83'ü (%41,5) erkekti. B/tsDMARD ile medyan tedavi süresi 6 (2-9) yıldı. Viral serolojik incelemelerde hastaların %1,5'inde HBsAg, %64,5'inde anti-HBs, %23,5'inde anti-HBc IgG ve %0,5'inde anti-HCV pozitifliği tespit edildi. Anti-HBc IgG pozitifliği oranı RA hastalarında (%34,8) axSpA hastalarına (%16,8) göre anlamlı derecede yüksekti ve PsA hastalarına (%22,2) benzerdi (p = 0,023). Ancak HBsAg, anti-HBs ve anti-HCV serolojileri hasta alt grupları arasında benzerdi (p > 0,05). Toplam 44 (%22) hasta oral antiviral profilaksi tedavisi altındaydı. Anti-HBc pozitif ve HBV DNA negatif olan 3 (%1,5) hasta antiviral tedavi uygulanmadan takip edildi. Hiçbir hastada viral reaktivasyon görülmedi.
Sonuç: Kohortumuzdaki yaklaşık dört hastadan biri anti-Hbc pozitifliği gösterdi ve neredeyse tamamı antiviral profilaksi kullanıyordu. Anti-HCV prevalansı çok daha düşüktü. Romatizmal hastalarda ve/veya hasta alt gruplarında viral hepatitleri ele alan hem ulusal hem de yerel düzeydeki çalışmalar, romatologların HBV ve HCV'yi yönetmede daha etkin olmalarını sağlayacaktır.

Keywords

Aksiyal spondiloartrit, HBV, HCV, psöriyatik artrit, romatoid artrit.

Examining the Seroprevalance and Antiviral Prophylaxis Rate of Hepatitis B and C Virus in Rheumatic Patients Treated with Biological and Targeted Synthetic Disease Modifying Anti-rheumatic Drugs: Results from a Tertiary Center in Central Anatolia

Abstract

Objective: To evaluate the epidemiological characteristics of hepatitis B virus (HBV) and hepatitis C virus (HCV) in rheumatic patients treated with biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs).
Methods: This cross-sectional study was carried out between September 2021 and April 2022 at the Rheumatology Outpatient Clinic of Erciyes University Faculty of Medicine, and it included 200 patients [113 with axial spondyloarthritis (axSpA), 18 with psoriatic arthritis (PsA) and 69 with rheumatoid arthritis (RA)]. The demographic and clinical characteristics, treatment details and viral hepatitis serology of the patients were recorded. Those not receiving biological and/or targeted synthetic DMARDs (b/tsDMARDs) were excluded.
Results: The median age of the patients was 47 (39-58) years, and the median disease duration was 10 (7-15) years. 117 (58.5%) of the patients were female, and 83 (41.5%) were male. The median duration of treatment with b/tsDMARDs was 6 (2-9) years. In the viral serological examinations, 1.5% of the patients were positive for HBsAg, 64.5% for anti-HBs, 23.5% for anti-HBc IgG, and 0.5% for anti-HCV. The anti-HBc IgG positivity rate was significantly higher in RA (34.8%) than axSpA patients (16.8%) and was similar to PsA patients (22.2%) (p = 0.023). Yet HBsAg, anti-HBs, and anti-HCV serologies were similar across patient subgroups (p > 0.05). A total of 44 (22%) patients were undergoing oral antiviral prophylaxis. Three (1.5%) patients who were anti-HBc positive and HBV DNA negative were followed without antiviral treatment. There was no viral reactivation in any patient.
Conclusion: Approximately one in four patients in our cohort showed anti-Hbc positivity, and almost all of them were using antiviral prophylaxis. Anti-HCV prevalence was much lower. Studies addressing viral hepatitis in rheumatic patients and/or patient subgroups, both at the national and local level, will enable rheumatologists to be more effective in managing HBV and HCV.

Keywords

Axial spondyloarthritis, HBV, HCV, psoriatic arthritis, rheumatoid arthritis

Ethical Statement

This study was approved by the Erciyes University Clinical Research Ethics Committee (Date:22 September 2021, Approval Number:2021/612). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all patients.

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