Finally, frequent monitoring alone is conditionally recommended over prophylactic antiviral therapy for patients initiating a tsDMARD or a bDMARD other than rituximab if they have evidence of a resolved hepatitis B infection.1 Dr. Ormseth noted that research on this subject has shown that abatacept as well as rituximab both are associated with a high risk of hepatitis B virus reactivation in patients with rheumatoid arthritis and resolved hepatitis B infection.6
In Sum
The lecture from Dr. Ormseth provided many clinical pearls regarding the treatment of rheumatoid arthritis and grounded these recommendations in the context of patient cases.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2021 Jul;73(7):924–939.
- Jain S, Dhir V, Aggarwal A, et al. Comparison of two dose escalation strategies of methotrexate in active rheumatoid arthritis: a multicentre, parallel group, randomised controlled trial. Ann Rheum Dis. 2021 Nov;80(11):1376–1384.
- Katz P, Margaretten M, Gregorich S, et al. Physical activity to reduce fatigue in rheumatoid arthritis: A randomized controlled trial. Arthritis Care Res (Hoboken). 2018 Jan;70(1):1–10.
- Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. N Engl J Med. 2022 Jan 27;386(4):316–326.
- Charles-Schoeman C, Buch M, Dougados M, et al. Risk factors for major adverse cardiovascular events in patients aged ≥50 years with RA and ≥1 additional cardiovascular risk factor: Results from a phase 3b/4 randomized safety study of tofacitinib vs. TNF inhibitors [abstract 0958]. Arthritis Rheumatol. 2021 Oct;73(suppl 9).
- Chen MH, Lee IC, Chen MH, et al. Abatacept is second to rituximab at risk of HBsAg reverse seroconversion in patients with rheumatic disease. Ann Rheum Dis. 2021 Nov;80(11):1393–1399.
