Summary

Introduction: Immunosuppressive drug use is common in the treatment of systemic lupus erythematosus (SLE). In cases receiving immunosuppressive therapy, screening for hepatitis B reactivation risk is also recommended. In this study, we aimed to investigate the frequency of hepatitis B screening in cases diagnosed as having SLE, who were followed up in the Rheumatology Clinic of Hatay Mustafa Kemal University.
Materials and Methods: We included 93 patients who were followed-up in the Rheumatology Clinic of Hatay Mustafa Kemal University with the diagnosis of SLE between July 2017-December 2019 in our study. The screening rates of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core protein antibody (anti-HBc IgG) of the cases and the immunosuppressive drugs used by them were analyzed retrospectively.
Results: The mean age of the cases was 38 years (minimum-maximum: 18-79), and 91.4% were women. Of the cases, 43 (46.2%) were determined to be never screened for hepatitis B, 34 (36.6%) screened inadequately, and only 16 (17.2%) screened fully. In 22 cases receiving high-risk immunosuppressive therapy, the rate of full screening of hepatitis B was 27.3%.
Conclusion: In patients with SLE, even those who used high-risk immunosuppressive therapy, screening rates were found low. We think that awareness should be increased in this regard by performing joint training with clinics that start immunosuppressive therapy, a periodic repetition of these trainings should be done, and also multi-center studies should be conducted.

References

1Lisnevskaia L, Murphy G, Iserberg D. Systemic lupus erythematosus. Lancet. 2014;384:1878-88.

2Cervera R, Khamastha MA, Font J, Sebastiani GD, Gil A, Lavilla P Aydintug AO, Jedryka-Góral A, de Ramón E, Fernández-Nebro A, Galeazzi M, Haga HJ, Mathieu A, Houssiau F, Ruiz-Irastorza G, Ingelmo M, Hughes GR. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore). 1999;78:167-75.

3Tsang-A-Sjoe MW, Bultink IEM. Systemic lupus erythematosus: review of synthetic drugs. Expert Opin Pharmacother. 2015;16:2793-806.

4Mok CC. Current role of rituximab in systemic lupus erythematosus. Int J Rheum Dis. 2015;18:154-63.

5Law MF, Ho R, Cheung CK, Tam LH, Ma K, So KC,Ip B, So J, Lai J, Ng J, Tam THC. Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies treated with anticancer therapy. World J Gastroenterol. 2016;22:6484-500.

6Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, Kaymakoglu S, Ergonul O. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21:1020-6.

7European Association For The Study Of The Liver. EASL 2017 Clinical Practice Guidelines on the Management of Hepatitis B Virus Infection. J Hepatol. 2017;67:370-98.

8Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HLY, Chen CJ, Chen D S, Chen P J, Chen HL, Chien RN, Dokmeci AK, Gane E, Hou J L, Jafri W, Jia J, Kim J H, Lai CL, Lee H C, Lim SG, Liu C J, Locarnini S, Mahtab MA, Mohamed R, Omata M, Park J, Piratvisuth T, Sharma BC, Sollano J, Wang FS, Wei L, Yuen MF, Zheng SS, Kao JH. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1-98.

9Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel SM, Ward JW. Centers for Disease Control and Prevention (CDC). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57:1-20.

10Kim DK, Bridges CB, Harriman KH, Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older-United States. MMWR Morb Mortal Wkly Rep. 2015;64:91-2.

11Patulla V. Prevention of hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219-37.

12Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT, American Gastroenterological Association Institute. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215-9.

13Aygen B, Demir AM, Gümüş M, Karabay O, Kaymakoğlu S, Köksal AŞ, Köksal İ, Örmeci N, Tabak F. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol. 2018;29:259-69.

14Reynolds JA, Manch RA, Gish RG. Medical interventions associated with HBV reactivation: Common and less common. Clinical Liver Disease 2015;5:32-4.

15Gu HR, Shin DY, Choi H, Moon CH, Park SC, Kang HJ. HBV reactivation in a HBsAg-negative patient with multiple myeloma treated with prednisolone maintenance therapy after autologous HSCT. Blood Res. 2015;50:51-3.

16Yılmaz N, Karadağ Ö, Kimyon G, Yazıcı A, Yılmaz S, Kalyoncu U, Kaşifoğlu T, Temiz H, Baysal B, Tözün N. Prevalence of hepatitis B and C infections in rheumatoid arthritis and ankylosing spondylitis: A multicenter countrywide study. Eur J Rheumatol. 2014;1:51-4.

17Dağlı Ö. Kasapoğlu Aksoy M. Ankilozan spondilitli hastalarda hepatit B ve hepatit C enfeksiyon prevalansı. Ortadoğu Tıp Derg. 2018;10:297-301.

18Wang S, Chen Y, Xu X, Hu W, Shen H, Chen J. Prevalence of hepatitis B virus and hepatitis C virus infection in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Oncotarget. 2017;8: 102437-45.

19Gendelman O, Mahroum N, Comaneshter D, Rotman-Pikielny P, Cohen A. D, Amital H, Sherf M. Hepatitis B carrier state among SLE patients: case–control study. Immunol Res. 2017;65:257-61.

20Engin B, Günay S, Binicier ÖB, Hakim GD, Yıldız C, Paköz ZB. Hepatitis B virus screening frequency and real life data in immunosuppressive patients. FNG & Bilim Tıp Dergisi. 2016;2:256-9.

21Ramirez J, Duddempudi AT, Sana MM, Hasan SS, de Los Santos M, Song J, Fang-Hollingsworth Y, Gupta SS, Sears DM. Screening for hepatitis B in patients with lymphoma. Proc (Bayl Univ MedCent). 2015;28:438-42.

22Aday FL, Link E, Thursky K, Rischin D. Current hepatitis B screening practices and clinical experience of reac-tivation in patients undergoing chemotherapy for solid tumors: a nationwide survey of medical oncologists. J Oncol Pract. 2011;7:141-7.

Frequency of Hepatitis B Virus Screening in Patients with Systemic Lupus Erythematosus

Summary

References