TY - JOUR
T1 - Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies
T2 - A retrospective cohort study and systematic review of the literature
AU - Snast, Igor
AU - Atzmony, Lihi
AU - Braun, Marius
AU - Hodak, Emmilia
AU - Pavlovsky, Lev
N1 - Publisher Copyright:
© 2017 American Academy of Dermatology, Inc.
PY - 2017/7
Y1 - 2017/7
N2 - Background Patients with psoriasis on biologic therapies and a history of viral hepatitis carry a risk for reactivation. Objective We evaluated safety of biologic therapies in psoriasis patients seropositive for hepatitis B or C viruses (HBV, HCV). Methods A retrospective cohort study design was used. Clinical and laboratory data for 30 patients undergoing biologic therapy who were seropositive for HBV or HCV were evaluated. Next, a systematic review was performed. Primary outcomes were hepatitis and viral reactivation during therapy. Treatment duration and antiviral prophylaxis were also recorded. Results Serology indicated HCV infection in 4 patients, past HBV infection in 17 patients, isolated core antibody in 8 patients, and chronic HBV infection in 1 patient. During follow-up (mean 4.85 ± 3.1 years), no patients experienced hepatitis or viral reactivation. The systematic review of the literature included 49 studies comprising 312 patients followed for a mean of 30.9 months. Viral reactivation occurred in 2/175 patients who were seropositive for core antibody and 3/97 with HCV infection (yearly rates, 0.32% and 2.42%, respectively) compared with 8/40 patients with chronic HBV infection (yearly rate, 13.92%). Three of these 8 patients with reactivated HBV infection received antiviral prophylaxis. Limitations We pooled heterogeneous studies evaluating different biologic therapies. Conclusion Biologic therapies pose minimal risk for viral reactivation in low-risk patients without hepatitis seropositive for HCV or HBV core antibody but are a considerable risk in patients with chronic HBV infection, highlighting the necessity of antiviral prophylaxis.
AB - Background Patients with psoriasis on biologic therapies and a history of viral hepatitis carry a risk for reactivation. Objective We evaluated safety of biologic therapies in psoriasis patients seropositive for hepatitis B or C viruses (HBV, HCV). Methods A retrospective cohort study design was used. Clinical and laboratory data for 30 patients undergoing biologic therapy who were seropositive for HBV or HCV were evaluated. Next, a systematic review was performed. Primary outcomes were hepatitis and viral reactivation during therapy. Treatment duration and antiviral prophylaxis were also recorded. Results Serology indicated HCV infection in 4 patients, past HBV infection in 17 patients, isolated core antibody in 8 patients, and chronic HBV infection in 1 patient. During follow-up (mean 4.85 ± 3.1 years), no patients experienced hepatitis or viral reactivation. The systematic review of the literature included 49 studies comprising 312 patients followed for a mean of 30.9 months. Viral reactivation occurred in 2/175 patients who were seropositive for core antibody and 3/97 with HCV infection (yearly rates, 0.32% and 2.42%, respectively) compared with 8/40 patients with chronic HBV infection (yearly rate, 13.92%). Three of these 8 patients with reactivated HBV infection received antiviral prophylaxis. Limitations We pooled heterogeneous studies evaluating different biologic therapies. Conclusion Biologic therapies pose minimal risk for viral reactivation in low-risk patients without hepatitis seropositive for HCV or HBV core antibody but are a considerable risk in patients with chronic HBV infection, highlighting the necessity of antiviral prophylaxis.
KW - HBcAg
KW - biologic
KW - hepatitis B virus
KW - hepatitis C virus
KW - psoriasis
KW - reactivation
KW - risk
UR - http://www.scopus.com/inward/record.url?scp=85019088919&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2017.01.037
DO - 10.1016/j.jaad.2017.01.037
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C2 - 28495497
AN - SCOPUS:85019088919
SN - 0190-9622
VL - 77
SP - 88-97.e5
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 1
ER -