{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:55:12Z","timestamp":1785128112926,"version":"3.55.0"},"reference-count":42,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: Tocilizumab has demonstrated optimal efficacy and safety in patients with rheumatoid arthritis (RA) from clinical trials. However, the risk of hepatitis B virus reactivation (HBVr) in these patients remains uncertain because patients with underlying HBV have been excluded in phase III studies. Methods: Systematical reviews were conducted on PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to 21 February 2023. Random-effects meta-analysis was performed to calculate the pooled incidence of HBV reactivation. Results: We included 0 clinical trials and 11 observational studies with a total of 25 HBsAg+ and 322 HBsAg\u2212\/anti-HBc+ RA patients. Among the HBsAg+ patients without antiviral prophylaxis, the pooled rate was 69.4% (95% CI, 32.9\u201391.3), with a median time of 4 months (range, 1\u20138 months) from tocilizumab initiated. Half of these patients with HBVr experienced hepatitis flare-up but no deaths. HBVr was eliminated with prophylaxis in this population. Among HBsAg\u2212\/anti-HBc+ patients, the pooled incidence of reactivation was 3.3% (95% CI, 1.6\u20136.7), with a median time of 10 months (range, 2\u201343 months) from tocilizumab initiated. HBVr was not associated with hepatitis flare-up and death. HBsAg\u2212\/anti-HBc+ patients without anti-HBs antibodies had a significantly higher risk of HBVr (Odds ratio, 12.20; 95% CI, 1.16\u2013128.06). Conclusions: This systematic review indicated that the risk of HBVr in RA patients with anti-HBs\u2212, HBsAg+, or HBsAg\u2212\/anti-HBc+ cannot be ignored but may be avoided. Clinicians should consider implementing appropriate antiviral prophylaxis and monitoring policies for RA patients to avoid unnecessary hepatic side effects from tocilizumab treatment.<\/jats:p>","DOI":"10.3390\/v16010078","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T03:18:07Z","timestamp":1704251887000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Risk of Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Receiving Tocilizumab: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"given":"Ping-Hung","family":"Ko","sequence":"first","affiliation":[{"name":"School of Medicine, Tzuchi University, Hualien 970, Taiwan"},{"name":"Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3124-3104","authenticated-orcid":false,"given":"Meng Hsuan","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Ting","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Wei","family":"Tseng","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzuchi University, Hualien 970, Taiwan"},{"name":"Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-6686","authenticated-orcid":false,"given":"Shih-Chieh","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"i21","DOI":"10.1136\/ard.59.suppl_1.i21","article-title":"Anti-interleukin 6 receptor antibody treatment in rheumatic disease","volume":"59","author":"Nishimoto","year":"2000","journal-title":"Ann. 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