Low value of routine serological screening for hepatitis B in patients with rheumatoid arthritis starting rituximab therapy in a nonendemic region
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives Rituximab (RTX) is an effective and safe treatment for rheumatoid arthritis (RA), but is associated with an increased risk of reactivation of hepatitis B virus (HBV) infection. Therefore, (inter)national guidelines recommend HBV screening prior to initiation of RTX treatment. However, the incidence of HBV in RA patients in nonendemic areas is expected to be very low, with known suboptimal screening adherence. This study aims to assess the added diagnostic value of routine serological HBV screening in RA patients initiating RTX. Methods This retrospective single-centre cohort study included all patients with a clinical diagnosis of RA intending to initiate RTX between April 2012 and April 2024. Data on patient and disease characteristics, HBV screening results, and additional laboratory results were collected. Adherence to HBV screening, proportion of positive test results (hepatitis B surface antigen or core antibody positive), and incidence of HBV reactivation were assessed. Results Of 975 included patients, 270 (28 %) were serologically screened for HBV. Six of those (2.2 %) had a positive screening result, of whom 3 eventually did not receive RTX. All 6 had a known HBV history or risk factor. No active HBV infections were observed after initiating RTX (mean follow-up 6.97 years), regardless of screening. Conclusions Routine serological HBV screening identified very few previously unrecognised infections, and—in spite of screening adherence being low—no HBV reactivations occurred. Routine serological HBV screening, therefore, seems redundant in a low-risk population and should be reserved for patients with known risk factors.Unlabelled box dummy alt text •Rituximab (RTX) increases the risk of hepatitis B reactivation in patients with chronic or resolved hepatitis B virus (HBV). Therefore, routine screening for HBV prior to the start of RTX is recommended by international guidelines. However, the added value of screening is unknown. •In our low-risk population, no relevant unknown cases of HBV were found through routine serological screening, and no reactivation of HBV was observed. Therefore, the added diagnostic value of routine serological screening and the risk for HBV reactivation are very low in this population. •Routine serological screening for HBV prior to the start of RTX treatment should not be done in low-risk populations and only in a few selected high-risk patients.
Source: EULAR Rheumatology Open
Language: English
Topic: Hepatitis B Virus Studies
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,080
OpenAlex ID: W7127090689