Patients should be screened for hepatitis B virus (HBV) infection before starting treatment with tumor necrosis factor (TNF) antagonists, according to a new retrospective analysis published in the journal Clinical Gastroenterology and Hepatology. 

The authors examined data from 8887 individuals who began TNF antagonist treatment for an autoimmune disease from 2001 through 2010 and were followed through 2012; 52% of these patients were screened for HBV before treatment. Results showed that 23 individuals tested positive for HB surface antigen (HBsAg) at baseline and 9 (39%) of these patients had HBV reactivation. Within the unknown HBV status group (N=4267), 2 patients (0/05%) had HBV reactivation. For these 11 patients, the median time from the first TNF antagonist treatment to HBV reactivation was 48 months; none of these patients had liver failure.

Of the 178 patients who were HBsAg-negative/hepatitis B core antibody positive (anti-HBc+), none had HBV reactivation. HBV reactivation occurred in 1 of 5 HBsAg+ patients on prophylactic antiviral therapy compared with 8 of 18 patients who did not receive prophylactic antiviral (P=.61). 

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“Our data support HBV screening prior to anti-TNF therapy and prophylactic antiviral therapy for HBsAg+ patients,” the authors write. “On the other hand, patients with past HBV infection, have low risk for [HBV reactivation], thus reassuring patients and physicians of the safety of anti-TNF in this cohort when indicated for chronic autoimmune disease.”

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