Biologic-Treated Patients With Psoriasis Have Higher Risk for HBV and HCV Reactivations

Hep C under microscope
Hep C under microscope
The biological treatment period represents a period of risk for HBVr and HCVr in patients with psoriasis receiving therapy, although prophylaxis with an anti-HBV agent significantly reduces the risk for HBVr.

Patients with psoriasis who are treated with biologics have a higher risk for hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivations, especially if they are young, hepatitis B surface antigen (HBsAg) seropositive, hepatitis B e-antigen (HBeAg) seropositive, and receiving tumor necrosis factor (TNF)-α inhibitor therapy, study data published in the Journal of the American Academy of Dermatology suggest.

University researchers from Taiwan reviewed the medical records of patients with psoriasis who had been treated with TNF-α inhibitors, interleukin (IL)-12/23 inhibitors, or IL-17 inhibitors. The investigators used baseline serology to categorize 561 patients with HBV infection into chronic HBV infection, resolved HBV infection, and occult HV infection categories. In addition, a total of 112 patients with HCV infection were included.

Overall, the cohort included 2060 patients with psoriasis treated with biologics between 2009 and 2018. A total of 3562 treatment episodes in the cohort were recorded. At baseline, every 3 months during a treatment episode, and at the end of treatment or follow-up, researchers measured HBV DNA/HCV RNA levels and serum alanine transaminase and aspartate transaminase levels. Reactivations of HBV and HCV viral loads were assessed to examine variables associated with reactivation and biologic-treated psoriasis.

A total of 14 treatment episodes for HCV involved reactivation of the virus during 1522 person-months follow-up (incidence, 110.4/1000 person-years). Univariate and multivariate analyses did not find significant predictors for HCV reactivation. Conversely, reactivation of HBV was observed in 72 treatment episodes for chronic HBV during 3012 person-months follow-up, compared with 3 treatment episodes for occult HBV and 13 for resolved HBV.

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Independent risk factors of HBV reactivation in the multivariable model included an absence of antiviral drug prophylaxis, HBsAg positivity, HBeAg positivity, and young age. In HBsAg-positive patients without antiviral prophylaxis, HBeAg positivity was an independent risk factor for HBV reactivation in the adjusted analysis (adjusted hazard ratio [aHR], 3.35; 95% CI, 1.30-8.67; P =.0126). Reactivation of HBV was more common in patients treated with TNF inhibitors vs IL-17 inhibitors (aHR, 2.67; 95% CI, 1.08-6.58; P =.033).

Limitations of the study include its observational design and lack of a comparison group, which the researchers suggest could have consisted of patients with psoriasis but without HCV or HBV infections and who were not treated with biologics.

Although the risk for HCV reactivation seems low in patients with chronic yet stable HCV, the researchers suggest that “monitoring of the HCV viral load is still recommended for psoriasis patients with chronic active HCV disease.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Chiu HY, Chiu YM, Chang Liao NF, et al. Predictors of hepatitis B and C virus reactivation in patients with psoriasis treated with biological agent: a nine-year multicenter cohort study [published online December 7, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.12.001