Igor Snast1, Lihi Atzmony1, Marius Braun2, Emmilia Hodak3, Lev Pavlovsky4. 1. Department of Dermatology, Rabin Medical Center Beilinson Hospital, Petach Tikva, Isreal. 2. Liver Institute, Rabin Medical Center Beilinson Hospital, Petach Tikva, Isreal; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Isreal. 3. Department of Dermatology, Rabin Medical Center Beilinson Hospital, Petach Tikva, Isreal; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Isreal. 4. Department of Dermatology, Rabin Medical Center Beilinson Hospital, Petach Tikva, Isreal. Electronic address: levp@clalit.org.il.
Abstract
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.
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 psoriasispatients 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.
Authors: Julie J Hong; Edward K Hadeler; Megan L Mosca; Nicholas D Brownstone; Tina Bhutani; Wilson J Liao Journal: J Psoriasis Psoriatic Arthritis Date: 2022-01-12
Authors: Luigi Gargiulo; Giulia Pavia; Mario Valenti; Ana Lleo de Nalda; Chiara Perugini; Antonio Costanzo; Alessandra Narcisi Journal: Dermatol Ther (Heidelb) Date: 2022-04-22
Authors: Marco Fiore; Sebastiano Leone; Alberto Enrico Maraolo; Emilio Berti; Giovanni Damiani Journal: Biomed Res Int Date: 2018-02-06 Impact factor: 3.411