Abstract
The risk of hepatitis B virus (HBV) reactivation has increased owing to advances in the immunosuppressive therapy field. However, the HBV reactivation incidence among patients with previously resolved HBV (prHBV) infection during immunosuppressive therapy for rheumatoid arthritis (RA) remains unclear. The objective of this work is to describe the validity of detecting prHBV infection from administrative data through comparisons with chart abstraction and determine the incidence of HBV reactivation during immunosuppressive therapy for RA in Japan. In this retrospective cohort study, data on selected patients were extracted from administrative claims data. To identify patients with prHBV infection and de novo hepatitis, and HBsAg carriers, we conducted chart abstraction. The incidence rate of de novo hepatitis was 1.23 of 100 person‐years. The positive predictive value (PPV) and its 95% confidence interval (CI) of administrative data for the identification of suspected prHBV infections was 85.8% (95% CI: 81.7%‐89.3%). This study evaluated the PPV of the algorithm of HBV‐DNA testing with immunosuppressive therapy performed four times or more per year for the detection of prHBV infection from administrative data. Additionally, we determined the incidence rate of HBV reactivation among preHBV infections during immunosuppressive therapy for RA to be 1.23 of 100 person‐years.
Highlights
The risk of hepatitis B virus (HBV) reactivation has increased owing to advances in immunosuppressive therapy.[1,2] In Japan, 23.2% of blood donors show HBcAb and/or HBsAb‐positivity,[1] and HBV reactivation due to immunosuppressive medication use is responsible for 6.8% of all fulminant hepatitis cases.[3]
The Japan College of Rheumatology, in collaboration with the Japan Society of Hepatology, published “A proposal for management of rheumatic disease patients with HBV infection receiving immunosuppressive therapy” in 2011,5 according to which, HBV carriers and previously resolved hepatitis B virus infection patients should be screened before immunosuppressive therapy or chemotherapy
We aimed to describe the validity of detecting previously resolved hepatitis B virus (prHBV) infection using administrative data through comparisons with chart abstraction because the information of medical charts and database under our organization can be linked to each other, and that allows us to determine the incidence of HBV reactivation during immunosuppressive therapy for rheumatoid arthritis (RA) across Japan
Summary
The risk of hepatitis B virus (HBV) reactivation has increased owing to advances in immunosuppressive therapy.[1,2] In Japan, 23.2% of blood donors show HBcAb and/or HBsAb‐positivity,[1] and HBV reactivation due to immunosuppressive medication use is responsible for 6.8% of all fulminant hepatitis cases.[3]. The risk of hepatitis B virus (HBV) reactivation has increased owing to advances in immunosuppressive therapy.[1,2]. Regarding the risk of HBV reactivation associated with the use of these agents, Japans Pharmaceuticals and Medical Devices Agency[4] issued an alert after several patients died of hepatic failure due to de novo hepatitis. The incidence of HBV reactivation among patients with prHBV infection during immunosuppressive therapy for rheumatoid arthritis (RA) is still unclear. We aimed to describe the validity of detecting prHBV infection using administrative data through comparisons with chart abstraction because the information of medical charts and database under our organization can be linked to each other, and that allows us to determine the incidence of HBV reactivation during immunosuppressive therapy for RA across Japan
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