Objective: To explore the liver safety of methotrexate(MTX) combined with iguratimod(IGU) on active rheumatoid arthritis(RA) patients under different status of HBV infection. Methods: Patients with active RA were enrolled from July 2019 to December 2020. All were treated with MTX in combination with IGU for 24 weeks. Adding with non-steroidal anti-inflammatory drugs(NSAIDs) or small doses of corticosteroids was permitted if constant pain observed. HBsAg+RA patients were suggested to be treated with anti-virus therapy preventively. Inflammatory marks, liver function, and HBV-DNA load were evaluated at baseline, 12th and 24th week. Results:Forty-seven patients with active RA were enrolled. Patients with active RA were grouped according to serum HBV biomarkers, including carrying HBV group(HBsAg+,n=8), past HBV infection group(HBsAg-but HBcAb or HBeAb+,n=21) and free of HBV infection group(HBsAg and HBcAb-,n=18). Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor showed a decreasing trend in all the groups, but there was no significant difference among them. 8.5% of the above developed aminotransferases elevation. In the carrying HBV group, 2 patients who refused antiviral prophylaxis developed HBV reactivation without aminotransferases elevation in 12th and 24th weeks. Conclusion: MTX combined with IGU therapy may induce mild aminotransferases elevation, and transient HBV reactivation, usually without hepatitis in active RA patients. They should be screened for liver function and HBV biomarker before therapy. Those with HBV infection were recommended to be treated with antiviral prophylaxis and monitor liver function and HBV-DNA load regularly. |
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