Hepatitis B Virus Screening and Reactivation in a National VA Cohort of Patients with Inflammatory Bowel Disease Treated with Tumor Necrosis Factor Antagonists
Practice guidelines recommend screening for hepatitis B virus (HBV) infection prior to initiating treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor (anti-TNF) therapy. However, the adherence to these screening guidelines and the clinical outcomes of HBV reactivation following anti-TNF use are not well known.
This is a retrospective cohort study using the Veterans Health Administration datasets for IBD patients with filled prescriptions for anti-TNFs from 2003 to 2011. Laboratory testing was used to define HBV screening status in the 12 months preceding anti-TNF initiation. Logistic regression models were used to identify predictors of HBV screening. Cases of potential HBV reactivation were identified using ICD-9 codes for HBV infection or acute liver failure or by medications used for HBV infection treatment, and manually reviewed for verification.
We identified 3357 IBD patients with filled prescriptions for anti-TNF medications. The HBV testing prior to anti-TNF initiation was 8.1% in 2003 and increased to 43.2% by 2011, with an overall rate of 23.7%. In multivariate analysis, African-American race, facilities with a higher volume of IBD patients, and facilities with an academic affiliation were associated with a higher probability of HBV screening. We did not identify a single case of confirmed clinically relevant HBV reactivation after anti-TNF initiation during 7210 patient-years of medication use.
HBV screening rates prior to anti-TNF initiation are low among IBD patients, but have increased over time. Despite low rates of screening, clinically significant HBV reactivation after anti-TNF initiation in this US cohort was nonexistent.
KeywordsInflammatory bowel disease Ulcerative colitis Crohn’s disease Hepatitis B Tumor necrosis factor
JH has served as a speaker for Abbvie, Janssen, a consultant for UCB, and served on an advisory board for Pfizer. JH has received research funding from Abbvie, Janssen, Pfizer, Celgene, and Redhill Biopharma. EH, RS, JK, PR, SS, and HE have no financial disclosures.
JH contributed to study design, data analysis, and authorship of manuscript. He has approved the final draft submitted. EYH contributed to authorship and editorial input of the manuscript. She has approved the final draft submitted. JRK contributed to study design, data analysis, and editorial input in the manuscript. She has approved the final draft submitted. PR contributed to study design, programming, data abstraction, data analysis, and editorial input in the manuscript. He has approved the final draft submitted. SS contributed to study design, programming, data abstraction, data analysis, and editorial input in the manuscript. She has approved the final draft submitted. HE contributed to study design, data interpretation, and editorial input in the manuscript. He has approved the final draft submitted. RS contributed to authorship and editorial input of the manuscript. He has approved the final draft submitted.
The research reported here was supported in part by the American College of Gastroenterology Junior Faculty Development Award (JKH) and with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX (JKH). No writing assistance was used in the preparation of this manuscript.