Biologic psoriasis treatment tied to reactivation of chronic HBV

Last Updated: 2017-05-22

By Reuters Staff

NEW YORK (Reuters Health) - Psoriasis patients with chronic hepatitis B virus (HBV) infection who are treated with biologic therapies are at increased risk of viral reactivation, new research shows.

But reactivation risk was minimal for patients who tested seropositive for HBV core antibody only or hepatitis C virus (HCV), Dr. Lev Pavlovsky of Rabin Medical Center Beilinson Hospital in Petach Tikva, Israel, and colleagues found.

Biologics available in Israel do not cause direct hepatic or renal toxicity, so they are an �€œappealing�€ option for patients with viral hepatitis, the researchers note in their report, online May 9 in the Journal of the American Academy of Dermatology. However, the researchers add, there have been reports of HBV reactivation in patients on biologic therapies for other illnesses.

To investigate the safety of biologics in patients testing positive for HBV or HCV, the researchers looked at clinical and laboratory data for 30 patients on biologic therapy, including four with HCV infection, 17 with past HBV infection, eight with isolated core antibody, and one patient with chronic HBV. During follow-up, which lasted an average of nearly five years, none of the patients developed hepatitis or viral reactivation.

The investigators also analyzed 49 studies found by systematic review of the literature. The studies included 312 patients followed for a mean 30.9 months. Yearly rates of viral reactivation were 0.32% in patients seropositive for core antibody, 2.42% in patients with HCV infection, and 13.92% in patients with chronic HBV infection.

One limitation of the study is that the review included heterogeneous studies of different biologic treatments, the researchers note.

�€œOur study indicates that low-risk patients without hepatitis who are seropositive for HBV core antibody only or HCV infection have minimal risk or no additive risk, respectively, for viral reactivation. Consequently, antiviral prophylaxis seems unnecessary,�€ Dr. Pavlovsky and colleagues write.

�€œIn contrast, chronic carriers of HBV have about a 14% risk for yearly viral reactivation. These patients need to be carefully evaluated for the risk-benefit ratio of biologic therapy and receive antiviral prophylaxis,�€ they add.

Dr. Pavlovsky was not available for an interview by press time.

SOURCE: http://bit.ly/2qHZN9s

J Am Acad Dermatol 2017.