Psoriasis patients on biologics at risk of HBV, HCV reactivation

Reactivations of hepatitis B (HBV) and C virus (HCV) are more likely among patients with psoriasis treated with biologic agents, especially those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumour necrosis factor-α inhibitor therapy, reveals a recent study.

The investigators screened up to 2,060 patients with psoriasis (3,562 treatment episodes) who were using biologics from 2009 to 2018 to determine the predictors of HBV and HCV reactivation. Of the participants, 359 had HBV (561 treatment episodes) and 61 had HCV (112 treatment episodes) infection.

During 8,809 and 1,522 person-months of follow-up, 88 and 14 treatment episodes involved HBV and HCV reactivations, respectively. The rate of reactivation was markedly higher in treatment episodes of chronic HBV infection relative to that of occult HBV (34.3 percent vs 3.2 percent; p=0001) and resolved HBV (34.3 percent vs 5.0 percent; p<0.001).

In multivariate analysis, being seropositive for hepatitis B surface antigen and hepatitis B e-antigen correlated with the risk of HBV reactivation, as did tumour necrosis factor-α inhibitor therapy. On the other hand, antiviral prophylaxis effectively reduced the risk of HBV reactivation. Of note, no predictors were found to significantly predict the risk of HCV reactivation.

“The increasing use of biologics is accompanied by a risk of HBV and HCV reactivation,” the investigators said.

This study was limited by its observational design and lack of a comparison group.