The use of interleukin 23 inhibitors in patients with chronic hepatitis B infection: A case series

Ch’en, Peter Yi; Farrer, Sterling; Miranda-Cacdac, Lauren; Song, Eingun James

doi:10.1016/j.jdcr.2022.09.023

Cited by 3 publications

(6 citation statements)

References 7 publications

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“…In psoriasis patients under anti‐IL‐23 therapy, serial TB‐IGRA demonstrated a low seroconversion rate (<1%) 54 . Anti‐IL‐23 inhibitors also appeared to be a safe choice in those with chronic inactive HBV 55 . The safety of half‐dose risankizumab was also demonstrated in this study up to 52 weeks.…”

Section: Discussionsupporting

confidence: 52%

Predictors for the effectiveness of 75 mg risankizumab in treating psoriasis—A real‐word evidence from a 52‐week retrospective study

Hsieh,

Tseng,

Tsai

2023

Experimental Dermatology

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In the registration trial of risankizumab for patients with moderate‐to‐severe psoriasis in Japan, similar Psoriasis Area Severity Index (PASI) responses were observed for 75 mg or 150 mg risankizumab at most time points up to 52 weeks, except for PASI 100 at week 16. The use of 75 mg risankizumab offers an attractive option considering the high cost of risankizumab. However, it is unknown whether patients with mild‐to‐moderate psoriasis respond similarly, and the efficacy data of non‐Japanese patients is also lacking. We retrospectively included 30 consecutive Chinese patients receiving half‐dose (75 mg) risankizumab as scheduled up to 52 weeks. Compared with biologic‐experienced group, biologic‐naive group had a significantly higher PASI 50/75/90/100 achievement (p = 0.0098/0.0039/0.0016/0.0054) at week 52. PASI 50/75/90/100 curves in biologic‐naive group (p = 0.0117/0.0239/0.0143/0.0269) were also significantly higher when analysed generalized estimating equations (GEE) model. Though there was no statistically significant difference in terms of PASI 50/75/90/100 responses at any time points between those with body weight ≦ 65 kg and those >65 kg, a tendency of secondary failure was noted in those >65 kg from week 40 onwards. Patients who were both biologic‐naive and weighed ≦ 65 kg achieved sustained PASI 50/75/90 responses from week 16/28/40 onwards, respectively, indicating that they could be considered as potential candidates for 75 mg risankizumab. Though PASI 75 curve in patients without diabetes mellitus (DM) surpassed that in patient without DM, curves of other parameters did not reach significance when analysed by GEE model. There was no HBV, HCV or TB reactivation, nor other new safety signals during the 52‐week observational period. Providing risankizumab with flexible dosing options is beneficial in clinical practice considering the high cost of this medication.

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Section: Discussionsupporting

confidence: 52%

Predictors for the effectiveness of 75 mg risankizumab in treating psoriasis—A real‐word evidence from a 52‐week retrospective study

Hsieh,

Tseng,

Tsai

2023

Experimental Dermatology

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“…18 Similarly, Ch'en et al reported the case of a man with HBcAb positive, HBsAb negative, HBsAg positive and HBV-DNA undetectable successfully treated with tildrakizumab and with a follow-up of 42 weeks. 19 To the best of our knowledge, our case is the first reporting a female patient affected by moderate-to-severe psoriasis and with chronic HBV infection undergoing prophylaxis, successfully treated with tildrakizumab without reporting hepatitis reactivation. Even if limited, our case seems to confirm available evidence about the safety of anti-IL-23, particularly tildrakizumab, on patients with chronic HBV infection undergoing prophylaxis.…”

Section: Discussionmentioning

confidence: 73%

“…In particular, the use of anti-TNFα seems to increase the risk of HBV reactivation, 6,9 while the use of recently anti-IL-17 and anti-IL-23 seems to have a lower risk of HBV reactivation. [10][11][12][13][14][15][16][17][18][19] Globally, screening for hepatitis before starting biological treatment is mandatory as well as a referral to an infectivologist and eventual prophylactic management should be evaluated case by case, also considering risk factors. 20,21 Patients with a resolved HBV infection do not require specialist follow-up while prophylactic treatment is necessary in patient with HBsAg positivity.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, in literature, there are only three cases of a patient with HBV history treated with tildrakizumab. 18,19 Gargiulo et al reported two male patients with HBV history (patient 1: HBcAb positive, HBsAb negative, HBsAg negative, HBV-DNA undetectable; patient 2: HBcAb positive, HBsAb positive, HBsAg negative, HBV-DNA undetectable) successfully treated with tildrakizumab without receiving prophylaxis for HBV infection and monitoring HBV reactivation up to 52 weeks. 18 Similarly, Ch'en et al reported the case of a man with HBcAb positive, HBsAb negative, HBsAg positive and HBV-DNA undetectable successfully treated with tildrakizumab and with a follow-up of 42 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…8 On the one hand, the use of anti-"Tumor Necrosis Factor" α (anti-TNFα) seems to increase the risk of HBV reactivation, 6,9 conversely, the use of recently approved classes of biologics anti-IL-17 and anti-IL-23 seems to have a lower risk of HBV reactivation. [10][11][12][13][14][15][16][17][18][19] The screening for hepatitis B is a routine measure before starting a treatment with biologics is recommended by current guidelines. 20 Patient with HBsAg positivity always require antiviral prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Tildrakizumab in a Patient with Chronic HBV Infection

Potestio¹,

Piscitelli²,

Fabbrocini³

et al. 2023

CCID

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The introduction of biologic drugs revolutionized the management of moderate-to-severe forms of psoriasis. However, safety concerns still remain, particularly on patient affected by opportunistic infections. In this scenario, the safety of biologic drugs in patient with HBV infection is debated. Globally, screening for hepatitis before starting biological treatment is mandatory as well as a referral to an infectivologist and eventual prophylactic management should be evaluated case by case, also considering risk factors. On the one hand, the use of anti-Tumor Necrosis Factor seems to increase the risk of HBV reactivation, conversely, the use of recently approved classes of biologics [anti-interleukin (IL) 17 and anti-IL23] seems to have a lower risk of HBV reactivation. However, the evidence on the safety of anti-IL23 drugs in patients affected by HBV is scant, particularly for patients undergoing treatment with tildrakizumab. Herein, we report the first case of a female patient affected by moderate-to-severe psoriasis and with chronic HBV infection undergoing prophylaxis, successfully treated with tildrakizumab without reporting hepatitis reactivation. Even if limited, our case seems to confirm available evidence about the safety of anti-IL23, particularly tildrakizumab, on patients with chronic HBV infection undergoing prophylaxis.

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Hepatitis B reactivation in PsA patients: an SLR and meta-analysis for IL-17, IL-23 and JAK inhibitors

Androutsakos,

Dimitriadis,

Koutsompina

et al. 2024

Rheumatology

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Objectives Hepatitis B reactivation (HBVr) constitutes a side effect of the treatment of autoimmune rheumatic diseases. Even though HBVr risk of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) and anti-tumor necrosis factor (anti-TNF) agents has long been established, the risk of targeted synthetic (ts)DMARDs and anti-interleukin (anti-IL) agents remains largely unknown. Methods We conducted a SLR (PubMed, Scopus and EMBASE) and metanalysis to examine the HBVr risk for the following: anti-IL17, anti-IL12/23, anti-IL23 and JAK-inhibitors in patients with chronic HBV infection (HBsAg presence or detectable HBV-DNA) and in patients with prior HBV infection (HBcAb-positive and HBsAg-negative). Meta-analysis was performed using both the fixed and random effects method and was conducted using the R computing language. Results Overall, our study revealed a low HBVr risk of < 6% in all agents; the risk was significantly higher for people having chronic compared with those with resolved HBV (14,4% vs 5.1%, respectively p< 0.01). There was no difference among different drugs in the HBVr rates [anti-IL-17: 4% (95% CI: 1–9%), anti-IL-12/IL-23: 2% (95% CI: 0–5%), JAK-inhibitors: 4% (95% CI: 1–8%), anti-IL23: 0%]. Of note, HBVr rate reached 28% in patients with chronic HBV who did not receive anti-viral treatment. For patients with resolved hepatitis the respective percentage was 4.7%. Conclusion Overall, our meta-analysis shows that patients with chronic HBV receiving anti-IL-17, anti-IL-12/23, anti-IL-23 and JAK-inhibitors have significant risk for HBVr, especially if they are not under anti-viral treatment. In contrast, resolved HBV seems to offer minor risk for HBVr even without anti-viral treatment.

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The use of interleukin 23 inhibitors in patients with chronic hepatitis B infection: A case series

Cited by 3 publications

References 7 publications

Predictors for the effectiveness of 75 mg risankizumab in treating psoriasis—A real‐word evidence from a 52‐week retrospective study

Predictors for the effectiveness of 75 mg risankizumab in treating psoriasis—A real‐word evidence from a 52‐week retrospective study

Efficacy and Safety of Tildrakizumab in a Patient with Chronic HBV Infection

Hepatitis B reactivation in PsA patients: an SLR and meta-analysis for IL-17, IL-23 and JAK inhibitors

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