Biologic therapies pose risk of reactivation in psoriasis patients with chronic HBV infection
The risk for viral reactivation with biologic therapies is negligible in low-risk patients without hepatitis seropositive for hepatitis B or C virus (HBV and HCV, respectively) core antibody, a recent study has found. However, biologic therapies pose a significant risk in patients with chronic HBV infection, stressing the need for antiviral prophylaxis.
Researchers assessed the safety of biologic therapies in psoriasis patients seropositive for HBV or HCV in this retrospective cohort study. They evaluated the clinical and laboratory data of 30 patients undergoing biologic therapy who were seropositive for HBV or HCV, and conducted a systematic review.
In addition, treatment duration and antiviral prophylaxis were recorded. Hepatitis and viral reactivation during therapy were the primary outcomes.
Serology showed past HBV infection in 17 patients, isolated core antibody in eight patients, HCV infection in four patients and chronic HBV infection in one patient. During a mean follow-up of 4.85 years, none of the patients experienced hepatitis or viral reactivation.
In the systematic review of literature, a total of 49 studies were included. These comprised 312 patients followed for a mean of 30.9 months.
Viral reactivation occurred less in patients who were seropositive for core antibody (two out of 175; yearly rate, 0.32 percent) and in those with HCV infection (three out of 97; yearly rate, 2.42 percent) compared with patients with chronic HBV infection (eight out of 40; yearly rate, 13.92 percent). Antiviral prophylaxis were administered in three of these eight patients with reactivated HBV infection.
The study was limited by the analysis of heterogeneous studies that evaluated different biologic therapies, according to researchers.