Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B.

Abstract

OBJECTIVE:

There are no previous studies on the use of abatacept in patients with chronic hepatitis B. This medical record review assessed the safety and efficacy of abatacept in 8 patients with rheumatoid arthritis (RA) and chronic hepatitis B.

METHODS:

A retrospective analysis of patients with RA and chronic hepatitis B treated with abatacept was conducted. The primary outcome was the 4-variable Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR) at each followup visit along with markers of hepatitis B reactivation, including aspartate aminotransferase, alanine aminotransferase, and hepatitis B viral load.

RESULTS:

A total of 47 visit data points were recorded. The mean ± SD duration of followup of patients receiving abatacept was 19.1 ± 12.7 months (range 3-33 months). Analysis was limited to 18 months of followup (included 77% of all visits [36 of 47]). Four patients were started on antiviral prophylaxis for hepatitis B with the initiation of abatacept, while 4 patients were not. Among the 4 patients who received antiviral prophylaxis, RA improved as evidenced by a statistically significant decrease in DAS28-ESR scores, and none had reactivation of hepatitis B. In the 4 patients without antiviral prophylaxis, there was no significant decrease in the DAS28-ESR scores and all 4 experienced reactivation of hepatitis B. There were no adverse events other than the hepatitis B reactivation.

CONCLUSION:

Use of abatacept in patients with RA and chronic hepatitis B appears feasible if antiviral prophylaxis for hepatitis B is given concurrently. In these patients there were no non-hepatitis-related adverse effects. These data are encouraging and should lead to initiation of controlled trials of abatacept in hepatitis B.

• Authors: Paul S Kim, Gerald Y Ho, Pamela E Prete, Daniel E Furst
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 64 Issue 8 Pg. 1265-8 (Aug 2012) ISSN: 2151-4658 [Electronic] United States
• PMID: 22392695 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 by the American College of Rheumatology.

Chemical References

• Antirheumatic Agents
• Antiviral Agents
• Immunoconjugates
• Tumor Necrosis Factor-alpha
• Abatacept

Topics

• Abatacept
• Aged
• Antirheumatic Agents (administration & dosage, adverse effects)
• Antiviral Agents (administration & dosage, adverse effects)
• Arthritis, Rheumatoid (complications, drug therapy)
• Comorbidity
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Immunoconjugates (administration & dosage, adverse effects)
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)