Meta‐analysis: hepatitis B reactivation in patients receiving biological therapy

Abstract

Background: The use of biologics poses a moderate to high risk for hepatitis B virus reactivation (HBVr) in chronic carriers.

Letter: Incidence of hepatitis B virus reactivation in patients with psoriasis treated with cytokine inhibitors

“…Our study supports the hypothesis that cytokine inhibitors used in patients with psoriasis can cause changes in the immune response, 6 potentially triggering HBVr. Similar to El Jamaly et al's report, which focused on ustekinumab, 1 we found that patients with psoriasis carried a similar risk of HBVr with all kinds of cytokine inhibitors. Among HBsAg+ patients without antiviral prophylaxis, the HBVr rate was 25%.…”

HBV reactivation in HBsAg−/HBcAb+ rheumatoid arthritis patients receiving biologic/targeted synthetic DMARDs

“…Additionally, the guideline recommends risk assessment and follow‐up policies based on the potency 6 . One meta‐analysis reported the pooled prevalence of HBV reactivation in patients with HBsAg−/HBcAb+ as follows: 2.6% (95% CI: 1.4%–4.7%, n = 18) for etanercept, 5.0% (95% CI: 2.8%–8.7%, n = 18) for adalimumab, and 7.1% (95% CI: 2.0%–21.7%, n = 4) for golimumab 29 . Etanercept appears to carry a lower risk of HBV reactivation, although this observation may be confounded by other clinical factors, as most of the studies that reported this finding did not adjust for confounders.…”

“…6 One meta-analysis reported the pooled prevalence of HBV reactivation in patients with HBsAg−/HBcAb+ as follows: 2.6% (95% CI: 1.4%-4.7%, n = 18) for etanercept, 5.0% (95% CI: 2.8%-8.7%, n = 18) for adalimumab, and 7.1% (95% CI: 2.0%-21.7%, n = 4) for golimumab. 29 Etanercept appears to carry a lower risk of HBV reactivation, although this observation may be confounded by other clinical factors, as most of the studies that reported this finding did not adjust for confounders. Our study accounted for potential confounding variables and found high-potency anti-TNF inhibitors as adalimumab also the independent factor for HBV reactivation.…”

“…Compared with other drugs, the risk of HBV reactivation associated with the use of TNF-α inhibitors in rheumatic patients with HBsAg−/HBcAb+ was more consistent. 16,29 In a recent meta-analysis which included 18 studies and 1564 HBsAg−/HBcAb+ patients receiving anti-TNF agents without NA prophylaxis, the pooled HBV reactivation risk was 1% (95% CI: 1%-2%). HBV reactivation-associated hepatitis developed in <0.1% of such patients without NA prophylaxis, and no patient developed hepatic decompensation or died.…”