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

Safety of biologics in psoriasis

“…Snast et al . published a systematic review of the published work including 49 studies about the risk of hepatitis B and C virus (HBV/HCV) reactivation in psoriatic patients receiving biologics.…”

“…The lower risk of HBV reactivation in psoriatic patients may reflect the less frequent use of concomitant immunosuppressants than in rheumatic patients . Patients with chronic HBV infection, characterized by antigen positivity regardless of the status of other serological markers, are at greatest risk for HBV reactivation . In immunosuppressed patients with chronic HBV infection, oral anti‐HBV agents have proven to be effective in reducing acute exacerbation and preventing fatal complications .…”

Safety Profile of Secukinumab in Treatment of Patients with Psoriasis and Concurrent Hepatitis B or C: A Multicentric Prospective Cohort Study

“…However, the aforementioned studies included not only patients with psoriasis, but also patients with other rheumatic and digestive diseases (22). A more recent review by Snast et al (17) included 40 patients with psoriasis with chronic HBV infection and found that virus reactivation was documented in 8 (20%) patients on biologic therapy. Our previous study showed that 2 of 7 (29%) patients, not receiving antiviral prophylaxis, exhibited HBV reactivation during treatment with IL-12/23 p40 monoclonal antibody ustekinumab (6).…”

“…However, only one case report (37) and 3 patients with coexisting HBV infection undergoing secukinumab therapy were included in a recent study (17). None of the patients experienced hepatitis or virus reactivation.…”

“…Outcome HBV virological reactivation was defined as a 10-fold increase in the HBV-DNA load, compared with the baseline value or a switch from the "undetectable" to the "detectable" status, and/or hepatitis B e antigen (HBeAg) seroconversion from negative to positive after secukinumab therapy (6,16,17). Hepatitis was defined as a ≥ 3-fold increase in ALT level that exceeded the upper limit of the normal value or an absolute increase in ALT level to > 100 IU/l (18).…”