Original article
Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies: A retrospective cohort study and systematic review of the literature

https://doi.org/10.1016/j.jaad.2017.01.037Get rights and content

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.

Section snippets

Retrospective cohort study

A retrospective cohort study design was used. The electronic database of the Dermatology Department of Rabin Medical Center, a tertiary referral hospital in Israel, was searched for patients treated with biologic agents for moderate-to-severe psoriasis since 2005. All patients were screened for HBV and HCV before initiation of biologic therapy. Positive HBV serology was subdivided into 3 categories according to the European Association for the Study of Liver Disease8: 1) resolved past HBV

Patients

Of the 207 patients with psoriasis treated with biologics during the study period, 30 (14.49%) had positive markers of HBV (n = 26) or HCV (n = 4) before treatment initiation.

Hepatitis B virus infection

The 26 patients with serologic evidence of HBV infection included 18 men and 8 women of mean age 56.3 (range 34-80) years. Their clinical (Table I) and laboratory (Table II) data are shown. All had long-standing plaque psoriasis (average duration 14.6 years, range 0.5-40 years); 2 patients (cases 7 and 14) also had a phase

Discussion

Up to 37.2% of patients with moderate-to-severe psoriasis are treated with biologic therapies.63 Therefore, it is crucial to define the safety profile of these agents in patients with concurrent serology suggestive of viral hepatitis.

Our cohort included low-risk patients without evidence of hepatitis who were seropositive for HBV or HCV. None of these patients experienced hepatitis or viral reactivation, supporting the safety of using biologics in this setting. The findings are reinforced by

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    Funding sources: None.

    Conflicts of interest: None declared.

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    © 2017 by the American Academy of Dermatology, Inc.