Incidence of Hepatitis B Virus Reactivation and Hepatotoxicity in Patients Receiving Long-term Treatment With Tumor Necrosis Factor Antagonists

Update of the statements on biology and clinical impact of occult hepatitis B virus infection

“…112 Earlier studies suggested that the risk is modest in individuals with OBI receiving tumor necrosis factor inhibitors, but recent studies found that the risk of HBV reactivation is very low in patients receiving these therapies. 103 Similarly, the risk of HBV reactivation is very low in individuals with OBI receiving direct-acting antiviral therapy for hepatitis C. [113][114][115] Given the shared transmission routes for HIV and HBV, and the immune impairment produced by HIV, OBI and HBV reactivations were more frequently reported in patients with acquired immunodeficiency syndrome. Following the widespread use of potent antiretroviral therapies, including antiretroviral agents with anti-HBV activity, reactivation of OBI has become negligible in the HIV population receiving appropriate therapy.…”

Hepatitis B virus persistence and reactivation

“…Several immunosuppressive therapies, including B or T cell depleting agents, biologics, cancer chemotherapeutic agents, corticosteroids, traditional immunosuppressants, and emerging novel cell therapy, can cause immune dysfunctions and the suppression of anti-HBV immunity (table 2). 112116117118119120127158…”

Asymptomatic reactivation of hepatitis B virus after prolonged treatment with etanercept

“…More recently, Lee et al published an extensive review of 269 cases of HBsAg-negative and anti-HBc-positive patients with rheumatic diseases treated with etanercept, which resulted in seven HBV reactivations (2.6%), but the majority of patients were also treated with a disease-modifying anti-rheumatic drug besides etanercept (10). To our knowledge, this is the first report of HBV reactivation in a patient receiving etanercept monotherapy for treatment of plaque psoriasis with a negative HBsAg prior to treatment (1,6,11,12).…”

“…Hepatitis B virus (HBV) reactivation associated with anti-tumor necrosis factor α (anti-TNFα) drugs for the treatment of immunomediated inflammatory diseases is rarely reported in the absence of surface hepatitis B antigen (HBsAg) (1). Etanercept, a soluble anti-TNFα, is the least associated with HBV reactivation (2).…”