Predictors of hepatitis B and C virus reactivation in patients with psoriasis treated with biologic agents: a 9-year multicenter cohort study - 11/06/21

Doi : 10.1016/j.jaad.2019.12.001

Hsien-Yi Chiu, MD, PhD ^a,^b,^c, Ying-Ming Chiu, MD, PhD ^d, Nien-Feng Chang Liao, MD ^e, Ching-Chi Chi, MD, MMS, DPhil (Oxford) ^f,^g, Tsen-Fang Tsai, MD ^b,^c, Chang-Yu Hsieh, MD ^b, Tsu-Yi Hsieh, MD, PhD ^h,^i,^j, Kuo-Lung Lai, MD ^h, Tsu-Man Chiu, MD ^k,^l,^m, Nan-Lin Wu, MD, PhD ^n,^o,^p, Rosaline Chung-yee Hui, MD, PhD ^f,^g,^q,^r, Chaw-Ning Lee, MD ^s, Ting-Shun Wang, MD ^b,^c,^t,^u, Po-Hua Chen, MD ^b,^v, Chao-Chun Yang, MD, PhD ^s, Yu-Huei Huang, MD, MS ^f,^g,^⁎
^a Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
^b Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
^c Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan
^d Department of Allergy, Immunology, and Rheumatology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
^e Department of Dermatology, China Medical University Hospital, Taichung, Taiwan
^f Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
^g School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
^h Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
ⁱ Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
^j Ph.D. Program of Business, Feng Chia University, Taichung, Taiwan
^k Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
^l Institute of Biochemistry, Microbiology, Immunology, Chung Shan Medical University, Taichung, Taiwan
^m Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
ⁿ Department of Medicine, Mackay Medical College, New Taipei, Taiwan
^o Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
^p Mackay Junior College of Medicine, Nursing, and Management, New Taipei, Taiwan
^q Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Taiwan
^r Department of Dermatology, Chang Gung Memorial Hospital, Keelung, Taiwan
^s Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
^t Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
^u Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
^v Department of Dermatology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan

^∗Correspondence and reprint requests to: Yu-Huei Huang, MD, MS, No. 5, Fuxing St, Guishan Dist, Taoyuan City 333, Taiwan (ROC).No. 5, Fuxing St, Guishan DistTaoyuan City333Taiwan (ROC)

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Abstract

Background

The increasing use of biologics is accompanied by a risk of hepatitis B (HBV) and C virus (HCV) reactivation.

Objective

To determine the predictors of HBV and HCV reactivation in patients with psoriasis receiving biologics.

Methods

This study screened 2060 patients with psoriasis (3562 treatment episodes) who were taking biologics from 2009 to 2018. There were 359 patients with psoriasis with HBV (561 treatment episodes) and 61 with HCV infection (112 treatment episodes).

Results

During 8809 and 1522 person-months of follow-up, 88 treatment episodes for HBV involved HBV reactivation, and 14 episodes of HCV involved reactivation. The reactivation rate was significantly higher in treatment episodes of chronic HBV infection than in that of occult HBV (34.3% vs 3.2%, P = .001) and resolved HBV (34.3% vs 5.0%, P < .001). The multivariate analysis revealed that being hepatitis B surface antigen seropositive, being hepatitis B e-antigen seropositive, and tumor necrosis factor-α–inhibitor therapy were risk factors for HBV reactivation, whereas antiviral prophylaxis was effective in reducing the risk of HBV reactivation. No predictors were significantly associated with HCV reactivation.

Limitations

Observational design and a lack of a comparison group.

Conclusion

Patients with psoriasis on biologics have a risk of HBV and HCV reactivations, particularly those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumor necrosis factor-α–inhibitor therapy.

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Key words : biologics, hepatitis B, hepatitis C, immunosuppressant, psoriasis, reactivation

Abbreviations used : ALT, CHBV, HBcAb, HBeAg, HBsAb, HBsAg, HBV, HBVr, HCV, HCVr, IL, IL-12/23i, IL-17i, RA, TE, TNF-α, TNFi

Plan

Clinical outcomes of patients with viral reactivation

Discussion

Conclusion

Funding sources: This work was funded in part by grants from the National Taiwan University Hospital, Hsin-Chu branch, Taiwan (106-HCH055, 110-HCH045), the Ministry of Science and Technology, Taiwan (formerly the National Science Council; grant numbers, MOST 107-2314-B-002-259-MY3), and Chang Gung Memorial Hospital (CMRPG2F0332). The funders had no role in the study design, data collection and analysis, interpretation of findings, manuscript writing, and target journal selection.

IRB approval status: The study protocol was reviewed and approved by the local Institutional Review Board of the National Taiwan University Hospital (201904124RINC, 201709006RIND and 201106079RC); National Taiwan University Hospital, Hsin-Chu branch (103-030-E); Chang Gung Medical Foundation (201900707B0); MacKay Memorial Hospital (19MMHIS135e); Changhua Christian Hospital (190609 and 131217); Taichung Veterans General Hospital (CE16265B); China Medical University Hospital (CMUH107-REC2-160); and National Cheng Kung University Hospital (A-ER-108-163).