June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Risk of Hepatitis B Virus reactivation in patients receiving systemic immunosuppressive therapies for uveitis: A Case Series
Author Affiliations & Notes
  • Kristina Frain
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Ren Ee Lee
    Barts Health NHS Trust, London, London, United Kingdom
  • Emilia Bober
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Camilo de resende
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Edward Hindle
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Selina Sandhu
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Said Hassan
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Jianfei Ma
    Rheumatology, Royal Free London NHS Foundation Trust, London, London, United Kingdom
  • Iain Ewing
    Hepatology, Homerton University Hospital NHS Foundation Trust, London, London, United Kingdom
  • Ian Yeung
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Carlos Pavesio
    Uveitis Service, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Kristina Frain None; Ren Ee Lee None; Emilia Bober None; Camilo de resende None; Edward Hindle None; Selina Sandhu None; Said Hassan None; Jianfei Ma None; Iain Ewing None; Ian Yeung None; Carlos Pavesio None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3566 – A0453. doi:
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      Kristina Frain, Ren Ee Lee, Emilia Bober, Camilo de resende, Edward Hindle, Selina Sandhu, Said Hassan, Jianfei Ma, Iain Ewing, Ian Yeung, Carlos Pavesio; Risk of Hepatitis B Virus reactivation in patients receiving systemic immunosuppressive therapies for uveitis: A Case Series. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3566 – A0453.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Oral Prednisolone (oPSL) at doses of ≥20 mg for ≥4 weeks is a well-documented moderate to high-risk factor for reactivation of chronic HBV (cHBV), especially in combination with immunosuppressants. Risk of iatrogenic cHBV reactivation in ophthalmology has not been reported. This retrospective case series describes cases of Uveitis with cHBV on oPSL and concurrent immunosuppressives to highlight the role for pre-treatment risk stratification for ophthalmologists.

Methods : Our large tertiary centre database was screened for uveitic patients receiving csDMARDs and had previous cHBV for inclusion. Patient records were retrospectively analysed and baseline patient characteristics, therapeutic, and serological data collected.

Results : 13 uveitic patients (8 female and 5 male) were included. Median age was 42 (±16.75). Sarcoidosis n=3 (23.1%) and VKH n=3 (23.1%) were the most represented uveitides. 11 patients (84.62%) received Prednisolone ≥20 mg for ≥4 weeks. Median duration in weeks oPSL >20mg was 10 (±37). Average maximum oPSL dose at each prescription was 60mg (±5). 6 patients (46.15%) were on Adalimumab. All patients were on csDMARD therapy. Of the 13 patients, 1 (7.69%) patient had reactivated HBV (rHBV) with a positive HbsAg during treatment. For the 1 patient with rHBV, the ALT level increased by 2857.69% from initial ALT measurement. 2 Patients (15.4%) required anti-HBV therapy.

Conclusions : This study demonstrated that Prednisolone can cause reactivation of cHBV in ophthalmology; our 7.69% reactivation rate is in keeping with the literature (<10%). Further higher-powered studies are warranted to identify causality and other independent predictors of reactivation in an ophthalmic patient population.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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