This study, presented at ACR Convergence 2023 by Akhil Sood, Janice Lin, and Neha Shah from Stanford University, examines the risk of Hepatitis B virus (HBV) reactivation in patients with rheumatoid arthritis (RA) who are being treated with either JAK inhibitors or IL-6 inhibitors. These drugs are part of a group called biologic/targeted synthetic DMARDs and are known to affect the immune system. Because of the immunosuppressive nature of these drugs, there is concern about the reactivation of HBV, a risk particularly significant in patients with underlying chronic or previously resolved HBV infections.
The researchers conducted a detailed search of medical databases for studies from January 1, 2010, to May 1, 2023, focusing on RA patients treated with these drugs. They looked specifically at patients who had either a current HBV infection (chronic) or a past infection that had resolved. The main outcome they measured was an increase in HBV DNA levels, which would indicate a reactivation of the virus.
Their meta-analysis included data from 16 studies and showed that patients with previously resolved HBV infection had a very low reactivation rate of 0.76%. However, patients with chronic HBV infection had a much higher reactivation rate of 26%. Additionally, the analysis revealed that JAK inhibitors are associated with a lower risk of HBV reactivation compared to IL-6 inhibitors in both groups.
The study concluded that while the overall risk of HBV reactivation in RA patients treated with these drugs is low, it is considerably higher in those with chronic HBV. The findings suggest JAK inhibitors might be a safer option compared to IL-6 inhibitors in terms of HBV reactivation risk. The authors recommend further research with larger patient groups to provide more definitive guidance for rheumatologists managing RA patients with underlying HBV.