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Patients with psoriasis treated with biologics have minimal risk of hepatitis B, C reactivation

Patients with moderate-to-severe psoriasis without hepatitis who were seropositive for hepatitis B core antibody only or hepatitis C infection, and who were being treated with biologic therapies, had minimal or no risk for viral reactivation, according to study results recently published in the Journal of the American Academy of Dermatology.

“Up to 37.2% of patients with moderate-to-severe psoriasis are treated with biologic therapies,” Igor Snast, MD, of the dermatology department, Rabin Medical Center Beilinson Hospital, Petach Tikva, Israel, and colleagues wrote. “Therefore, it is crucial to define the safety profile of these agents in patients with concurrent serology suggestive of viral hepatitis.”

Researchers conducted a retrospective cohort study of clinical and laboratory data from the dermatology department of Rabin Medical Center, for 30 patients with moderate-to-severe psoriasis treated with biologics since 2005. The patients were seropositive for hepatitis B (HBV; mean age, 56.3 years) or hepatitis C (HCV; mean age, 62.3 years).

The researchers also conducted a systematic literature review using PubMed.

Hepatitis and viral reactivation during therapy were primary outcomes, with treatment duration and antiviral prophylaxis noted.

In the cohort study, serology showed evidence of four patients with HCV infection; 17 patients with past HBV infection; eight patients with isolated core antibody and one patient with chronic HBV infection. No patients experienced hepatitis or viral reactivation during a mean follow-up time of 4.85 years.

The 49 studies in the systematic review included 321 patients who were followed for a mean time of 30.9 months. Among the 175 patients seropositive for core antibody, two experienced viral reactivation (yearly rate, 0.32%). Three of the 97 patients with HCV had viral reactivation (yearly rate, 2.42%) compared with eight of 40 patients with chronic HBV infection (yearly rate, 13.92%). Of the eight patients with viral reactivation of HBV, three had received antiviral prophylaxis.

“Our 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, the antiviral prophylaxis seems unnecessary,” the researchers concluded. “In contrast, chronic carriers of HBV have about a 14% risk of yearly viral reactivation. These patients need to be carefully evaluated for the risk benefit ratio of biologic therapy and receive antiviral prophylaxis.”– by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.