Differential group risk and treatment strategies in patients with rheumatoid arthritis with occult hepatitis B virus infection
| Targets of treatment Prophylaxis should start 1 week before beginning immunesuppression therapy | HBsAg negative, anti-HBc positive | |
| High risk (>10%) | B-cell-depleting anti-CD20-directed monoclonal antibodies (eg, rituximab, epratuzumab, ocrelizumab, obinutuzumab and ofatumumab) Glucocorticosteroids>20 mg/day+csDMARDs | Prophylaxis with lamivudine or TDF/TAF/ETV |
| Moderate risk (1%–10%) | Glucocorticosteroids>10<20 mg/day for >4 weeks TNF-I, tocilizumab, JAK 1–2, 1–3, 1-TYK-2 inhibitors | Prophylaxis with lamivudine or TAF, TDF/ETV if therapy lasts >12 months |
| Low risk (<1%) | Glucocorticoid<10 mg/day Methotrexate Leflunomide Sulfasalazine Hydroxychloroquine Abatacept | Monitor HBsAg, ALT and HBV DNA every 3 months |
Modified from Perrillo et al.12
csDMARD, conventional synthetic disease-modifying antirheumatic drug; ETV, entecavir; HBc, hepatitis B virus core protein; HBsAg, hepatitis B surface antigen; JAK, Janus kinase; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil; TNF, tumour necrosis factor; TYK, Tyrosin Kinase.