Treatment of Rheumatoid Arthritis Patients with Chronic Hepatitis B: Analysis of Korean National Health Insurance Claims Data

Kichul Shin; Hyeongap Jang; Won Mo Jang; Jin-Seok Lee; Yeong-Wook Song

doi:10.4078/jrd.2013.20.1.24

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Shin, Jang, Jang, Lee, and Song: Treatment of Rheumatoid Arthritis Patients with Chronic Hepatitis B: Analysis of Korean National Health Insurance Claims Data

Original Article

J Rheum Dis 2013;20(1):24-29.

Published online: 31 February 2013

DOI: https://doi.org/10.4078/jrd.2013.20.1.24

Treatment of Rheumatoid Arthritis Patients with Chronic Hepatitis B: Analysis of Korean National Health Insurance Claims Data

Kichul Shin¹, Hyeongap Jang², Won Mo Jang², Jin-Seok Lee², Yeong-Wook Song^1,³

¹Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea

²Department of Health Policy Management, College of Medicine, Seoul National University, Seoul, Korea

³WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Center, College of Medicine, Seoul National University, Seoul, Korea

Corresponding to : Yeong-Wook Song, Divsion of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul National University, 101, Daehak-ro Jongno-gu, Seoul 110-744, Korea. E-mail : ysong@snu.ac.kr

Received 1 January 20136 January 2013 Accepted 9 January 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

There are currently limited treatment options for rheumatoid arthritis (RA) patients with chronic hepatitis B (CHB). In the process of pursuing further treatment strategies for this subgroup of patients, it is prudent to study what medications have been commonly prescribed, particularly for disease modifying antirheumatic agents (DMARDs) in Korea.

Methods

We analyzed the Korean National Health Insurance claims database (2007∼2009) of RA patients through co-working with the Clinical Research Center for RA (CRCRA). Patients with CHB were defined by an al-gorithm including prescription information, blood tests, and the ICD-10 code.

Results

There were 8,677 CHB patients (3.8%) among 226,592 RA patients in the database. The age distribution or gender difference in CHB patients was comparable to the general RA population. Hydroxychloroquine was the most frequently (66.2%) prescribed DMARD. Thirty four percent of CHB patients had been prescribed with methotrexate (MTX) during the study period; most of them without concomitant anti-viral treatment. About 3% of RA patients with CHB were prescribed with TNF inhibitors.

Conclusion

Apart from the published expert recommendations, MTX still seems to be one of the main DMARDs prescribed to Korean RA patients with CHB. This is most likely due to the lack of evidence-based, effective treatment strategies for this subgroup of patients.

Keywords: Rheumatoid arthritis, Chronic hepatitis B, Methotrexate, Treatment

References

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Figure 1.

Classifying RA patients with chronic hepatitis B. Patients were selected using prescription information, laboratory tests, and ICD-9 code. Patients were pooled (1+2+3+4) for further analysis (∗at least 2 incidents, ^† at least 1 incident of blood test). RA: rheumatoid arthritis, PEG-IFN: pegylated interferon, HBV: hepatitis B virus, AFP: alpha fetoprotein.

Table 1.

Characteristics of RA patients in this study (n=226,592)

Characteristics	Number of patients (%)
Age, years
<30	12,265 (5.4)
30∼39	24,016 (10.6)
40∼49	43,095 (19.0)
50∼59	62,210 (27.5)
60∼69	50,576 (22.3)
70∼79	28,847 (12.7)
≥80	5,583 (2.5)
Total	226,592 (100)
Gender, female	173,543 (76.6)
Insurance type
National health insurance	211,248 (93.2)
Medical aid	15,344 (6.8)
Corticosteroid use^∗	206,005 (90.9)

RA: rheumatoid arthritis,

^∗ Prescribed at least twice during study period

Table 2.

Characteristics of RA patients with chronic hepatitis B (n=8,677)

Characteristics	Number of patients (%)	Prevalence of CHB in each age group
Age, years
<30	368 (4.2)	3.0%
30∼39	941 (10.8)	3.9%
40∼49	1,813 (20.9)	4.2%
50∼59	2,805 (32.3)	4.5%
60∼69	1,884 (21.7)	3.7%
70∼79	751 (8.7)	2.6%
≥80	115 (1.3)	2.0%
Total	8,677 (100)	3.8%
Gender, female	6,329 (72.9)

RA: rheumatoid arthritis, CHB: chronic hepatitis B

Table 3.

Conventional DMARD or corticosteroid use in RA patients with chronic hepatitis B

	Drugs	Number of patients prescribed with drug (%)^∗
Conventional	Hydroxychloroquine	5,747 (66.2)
DMARDs	Methotrexate	2,948 (34.0)
	Sulfasalazine	2,521 (29.1)
	Leflunomide	778 (9.0)
	Cyclosporine	373 (4.3)
	Azathioprine	291 (3.4)
	Tacrolimus	270 (3.1)
Oral corticosteroids	Prednisolone	5,853 (67.5)
	Triamcinolone	4,802 (55.3)
	Methylprednisolone	4,631 (53.4)
	Deflazacort	505 (5.8)

DMARD: disease modifying antirheumatic drug, RA: rheumatoid arthritis,

^∗ Prescribed at least twice during study period

Table 4.

Anti-viral agent prescription with MTX in RA patients with chronic hepatitis B (MTX users n=2,948)

Drug	Number of patients prescribed with anti-viral agent (%)^∗
Entecavir	126 (4.3)
Lamivudine	37 (1.3)
Clevudine	35 (1.2)
Adefovir	24 (0.8)
Total	222 (7.6)

MTX: methotrexate, RA: rheumatoid arthritis,

^∗ Prescribed at least twice during study period

Table 5.

Biologic DMARD use in RA patients with chronic hepatitis B

Drug	Number of patients prescribed with biologic DMARD (%)^∗
Etanercept	118 (1.4)
Adalimumab	110 (1.3)
Infliximab	36 (0.4)
Rituximab	43 (0.5)
Total	307 (3.6)

DMARD: disease modifying antirheumatic drug, RA: rheumatoid arthritis,

^∗ Prescribed at least twice during study period

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