目的:本研究的目的是评估抗IL-6治疗下RA患者HBV再激活(HBVr)的可能性。
方法:使用PubMed,Scopus和EMBASE,我们进行了系统的文献检索,寻找抗IL-6治疗的RA患者中与HBVr相关的文章.搜索没有日期限制,最后更新于2023年1月28日。合并所有数据库的结果,排除重复项,就像非英语文章一样,病例报告,定位文章,注释,和儿科研究。
结果:我们最初的搜索导致了427篇文章;28是重复的,46非英语,169条评论,31本书/字母,25例病例报告,88个与荟萃分析目标无关;21个由于信息不足而被排除在外,留下19篇文章,与372例RA患者慢性HBV(CHB)或解决HBV感染的总和,作进一步分析。总体风险为HBVrRA患者CHB为6.7%,增加到37%,当仅RA患者与CHB和无抗病毒预防包括在内。相反,HBVr是接近0%的RA患者解决HBV感染,无论抗病毒预防。在这些研究中,所有经历HBVr的RA患者都成功地进行了抗病毒治疗和/或停药。
结论:总体而言,抗IL-6治疗伴随着RACHB患者HBVr的显着风险;当使用抗病毒预防时,风险降低。相比之下,在RA患者中,HBV感染已解决,HBVr的风险似乎极低。大,需要精心设计的研究(对照试验或多中心/国际观察性研究)来进一步验证这些结果.
The objective of this study was to assess the possibility of HBV reactivation (HBVr) in patients with RA under anti-IL-6 treatment.
Using PubMed, Scopus and EMBASE, we performed a systematic literature search for articles related to HBVr in RA patients under anti-IL-6 treatment. The search was performed with no date limits and was last updated 28 January 2023. The results from all the databases were combined and duplicates were excluded, as were non-English articles, case reports, position articles, comments, and paediatric studies.
Our initial search led to 427 articles; 28 were duplicates, 46 non-English, 169 reviews, 31 books/letters, 25 case reports, and 88 irrelevant to the meta-analysis aim; 21 were excluded due to inadequate information, leaving 19 articles, with a sum of 372 RA patients with chronic HBV (CHB) or resolved HBV infection, for further analysis. The overall risk for HBVr in RA patients with CHB was 6.7%, increasing to 37% when only RA patients with CHB and no antiviral prophylaxis were included. On the contrary, HBVr was close to 0% in RA patients with resolved HBV infection, irrespective of antiviral prophylaxis. All RA patients experiencing HBVr in these studies were successfully managed with antiviral treatment and/or drug withdrawal.
Overall, anti-IL-6 treatment comes with a significant risk of HBVr in RA patients with CHB; risk is diminished when antiviral prophylaxis is used. In contrast, in RA patients with resolved HBV infection, the risk of HBVr seems to be extremely low. Large, well-designed studies (either controlled trials or multicentre/international observational studies) are warranted to further validate these results.