Table 1

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
TDF/ETV if therapy lasts >12 months
Low risk (<1%)Glucocorticoid<10 mg/day
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.