The outcome study of rheumatic disease patients with chronic hepatitis B infection
10.3760/cma.j.issn.1007-7480.2009.05.011
- VernacularTitle:风湿病合并慢性乙型肝炎病毒感染患者用药安全性的临床研究
- Author:
Hua YE
;
Shi CHEN
;
Zhanguo LI
- Publication Type:Journal Article
- Keywords:
Rheumatic disease;
Hepatitis B,chronic;
Immunosuppressive agents;
Glucocorticoids
- From:
Chinese Journal of Rheumatology
2009;13(5):324-327
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the outcomes of chronic hepatitis B (CHB) infection following immunosuppressant and corticosteroid treatment in patients with rheumatic disuses.Methods The medical records of patients with positive HBsAg and rheumatic diseases from 1 Jan 2004 to 31 Dec 2007 were retros pectively reviewed and analyzed for the types of rheumatic diseases,hepatitis B seroiogies,name and dosage of immunosuppressive agents used,anti-viral therapies and outcomes of CHB infection.Results Twenty one patients were included.There were 14 female and 7 male patients.The mean age of all patients was (45±16)years.All patients were positive for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HbcAb),and had alanine aminotransferase (ALT) less than 60 U/L except one patient with dermatomyositis.Twelve(57%) patients treated with immunosuppressant only.Among them,rheumatoid arthritis (75%) was the most commonly diagnosed rheumatic diseases.These patients were treated with methotrexate (no more than 10 mg per week) or leflunomide ( 10 mg/d),combined with suffasalazine or hydroxychloroquine.Three patients received antivirus drugs because of the elevation of HBV-DNA.During the follow-up period (7 to 47 months with a median of 25 months),four (33%) developed ALT elevation,but none had developed HBV reactivation.Nine (43%) patients were treated with prednisolone and /or immunosuppressants.Among them,5 (56%)patients were diagnosed as systemic lupus erythematosus,others were adult onset of Still's disease and dermatomyositis,and 3 patients had elevation of HBV-DNA copies.These patients were treated with predni-soione (0.8～1.2 mg·kg-1·d-1) only or combined with immunosuppressants (methotrexate or cyclophosphamide),and all patients received antivirus drugs.During the follow-up period (3 to 50 months with a median of 13 months),two developed ALT elevation,but none had developed HBV reactivation.Conclusion In patients with rheumatic disease complicated with chronic HBV infection,methotrexate (no more than 10 mg per week) and leflunomide (10 rag/d) may be safe for patients with negative HBV-DNA.Prednisolone and immunosuppressants (methotrexate or cyclophosphamide) may be used safely with prophylactic antivims drugs.
