Abstract

Introduction

Notwithstanding their numerous advantages, biological treatments have many limitations when treating patients with psoriasis (PsO) and hepatitis B (HB). Clinicians need to pay careful attention to the issue of hepatitis B virus (HBV) reactivation.

Methods

In accordance with the PRISMA guidelines, we systematically searched Pubmed, Scopus, Embase, Cochrane Library, and Web of Science databases for observational studies on the topic of HBV reactivation among patients with PsO and HB treated with biologics. The random-effects model was used to pool the reactivation rate by the Freeman–Tukey double arcsine transformation method. We selected Fisher’s exact test to compare multiple rates. To determine the sources of heterogeneity, sensitivity analysis and meta-regression were performed.

Results

Ten studies with a total of 238 subjects that met the inclusion criteria were included. The pooled reactivation rate was 1.8% [95% confidence interval (CI) 0.0–5.6%] in patients with PsO and HB. Among them, the viral reactivation rates of HBsAg-positive and HBsAg-negative patients were 4.1% (95% CI 0.0–17.9%) and 0.2% (95% CI 0.0–2.8%). The difference between HBsAg-positive and HBsAg-negative patients was statistically significant (p = 0.002). The viral reactivation rate of individuals who needed antiviral prophylaxis but did not receive it was 26.6% (95% CI 5.8–53.5%), while it decreased to 0.0% (95% CI 0.0–6.6%) after accepting antiviral treatment. The two-sided Fisher’s test exact values between different durations of biological therapy showed no statistical significance (p = 0.104).

Conclusions

Without antiviral prophylaxis, HBsAg-positive patients with psoriasis are at high risk of virus reactivation when treated with biological agents. Early and sufficient antiviral prophylaxis will effectively reduce the risk of HBV reactivation and serious complications in HBsAg-positive patients. Prolonging the duration of biological treatment will not increase the risk of reactivation.

Details

Title
Risk for Hepatitis B Virus Reactivation in Patients with Psoriasis Treated with Biological Agents: A Systematic Review and Meta-Analysis
Author
Wang, Xinyu 1 ; Zhang, Ming 1 ; Chen, Yu 2 ; Liu, Yirong 3 ; Yu, Yan 1 ; Huang, Xiaojie 4 ; Gao, Yanqing 5   VIAFID ORCID Logo 

1  Beijing Youan Hospital, Capital Medical University, Department of Dermatology, Beijing, China (GRID:grid.414379.c) 
2  Beijing Youan Hospital, Capital Medical University, Fourth Department of Liver Disease (Difficult and Complicated Liver Diseases and Artificial Liver Center), Beijing, China (GRID:grid.414379.c) 
3  Beijing Youan Hospital, Capital Medical University, Outpatient Department, Beijing, China (GRID:grid.414379.c) 
4  Beijing Youan Hospital, Capital Medical University, Center for Infectious Diseases, Beijing, China (GRID:grid.414379.c) 
5  Beijing Youan Hospital, Capital Medical University, Department of Dermatology, Beijing, China (GRID:grid.414379.c); Candidate Branch of National Clinical Research Center for Skin Diseases, Beijing, China (GRID:grid.414379.c) 
Pages
655-670
Publication year
2022
Publication date
Mar 2022
Publisher
Springer Nature B.V.
ISSN
21938210
e-ISSN
21909172
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1007/s13555-022-00682-5
ProQuest document ID
3223885713
Copyright
© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.