P322 Hepatitis B reactivation under biologic therapy in patients with HBsAg negative phase of chronic HBV infection

Abstract Background Biologic agents are widely used in immune mediated inflammatory diseases (IMID). The risk and consequences of hepatitis B reactivation in hepatitis B surface antigen (HBsAg) negative phase of hepatitis B virus (HBV) exposed patients is not clear. We aim to investigate the reactiv...

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Published in:	Journal of Crohn's and colitis Vol. 15; no. Supplement_1; pp. S347 - S348
Main Authors:	Ergenç, I, Kani, H T, Karabacak, M, Cömert Özer, E, Mehdiyev, S, Jafarov, F, Abacar, K Y, Kutluğ Ağaçkıran, S, Seven Sevik, G, Alibaz Öner, F, İnanç, N, Atagündüz, M P, Gençosmanoğlu, D S, Özen Alahdab, Y, Ergun, T, Direskeneli, R H, Atuğ, Ö
Format:	Journal Article
Language:	English
Published:	27-05-2021
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Summary:	Abstract Background Biologic agents are widely used in immune mediated inflammatory diseases (IMID). The risk and consequences of hepatitis B reactivation in hepatitis B surface antigen (HBsAg) negative phase of hepatitis B virus (HBV) exposed patients is not clear. We aim to investigate the reactivation rate in biologic exposed patients within surface antigen negative phase of HBV infection. Methods We identified patients followed up at gastroenterology, rheumatology and dermatology out-patient clinics with a diagnosis of IMID from clinical charts. Patients exposed to biologic agents with a negative HBsAg and positive Anti-HBc IgG were included. Primary outcome was HBV reactivation, which was defined as reverse seroconversion of HBsAg. Results We screened 8266 IMID patients and 2484 of them were exposed to biologic agents. A total of 221 patients were included in the study. The mean age was 54.08 ± 11.69 years and 115 (52.0%) patients were female. The median number of different biologic subtype use was 1 (range: 1 – 6). The mean biologic agent exposure time was 55 (range: 2 – 179) months. One hundred and fifty-two (68.8%) patients were using concomitant immunomodulatory agents and 84 (38.0%) patients were exposed to corticosteroids during biologic use. No hepatitis B reactivation with a reverse seroconversion of HBsAg positivity was observed in the whole cohort. Antiviral prophylaxis for hepatitis B was given to 48 (21.7%) patients with entecavir, tenofovir or lamivudine. HBV-DNA was screened in 56 (25.3%) patients prior to the biologic exposure. Two patients had HBV-DNA reactivation with a negative HBsAg during exposure to the biologic agent. Conclusion Though only 21.7% of our patients used prophylaxis, we found only two reactivations (1%) and no HBsAg seroconversion in our cohort. Our results suggest a re-assessment of antiviral prophylaxis for anti-HBc Ag (+) patients exposed to biologic agents. Current guidelines would be updated in the light of future studies.
ISSN:	1873-9946 1876-4479
DOI:	10.1093/ecco-jcc/jjab076.446