Viral hepatitis screening guideline before biological drug use in rheumatic patients

KARADAĞ Ö., Kasifoglu T., Ozer B., Kaymakoglu S. , KUS Y., Inanc M. , ...More

EUROPEAN JOURNAL OF RHEUMATOLOGY, vol.3, no.1, pp.25-28, 2016 (Journal Indexed in ESCI) identifier identifier

  • Publication Type: Article / Review
  • Volume: 3 Issue: 1
  • Publication Date: 2016
  • Doi Number: 10.5152/eurjrheum.2015.150072
  • Page Numbers: pp.25-28


Biological drugs (tumor necrosis factor inhibitors, rituximab, tocilizumab, abatacept, and tofacitinib) are important treatment alternatives in rheumatology, particularly for resistant patients. However, they may cause hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivation; for instance, HBV reactivation may occur in a patient who is an inactive hepatitis B surface antigen (HBsAg) carrier or who has resolved HBV infection. Therefore, the screening of patients before biological treatment and the application of a prophylactic treatment, particularly with respect to latent HBV infections, are recommended when necessary. This guideline covers pre-treatment screening and follow-up recommendations, if required, with respect to viral hepatitides in rheumatology patients who are planned to be given biological drugs. Although this guideline is prepared for biological disease-modifying antirheumatic drugs (DMARDs), it is recommended to be used also for target-oriented DMARDS and medium-high dose corticosteroids (>7.5 mg prednisolone/day equivalent). It should be considered that the reactivation risk is higher when more than one immunosuppressive drug is used.