Biologics and Reactivating Hepatitis: What is the Risk?
Biologics provide an effective treatment for moderate-to-severe psoriasis, but some studies showed an increase in opportunistic infections in patients using biologic therapies. Biologics have advantages for use with patients with concurrent hepatitis because these agents lack direct hepatic or renal toxicity. Tumor necrosis factor-alpha (TNF-alpha) inhibitors are biologic agents that are effective for treating psoriasis, but TNF-alpha is also an important cytokine in host antiviral defense. There are some reports that have described hepatitis B virus (HBV) reactivation following TNF-alpha inhibitor use in patients with rheumatoid arthritis and spondyloarthropathies. These reports elicited concern that a similar effect may be seen for psoriasis patients exposed to HBV or hepatitis C virus (HCV).
A recent study sought to evaluate the safety profile of biologic therapies among psoriasis patients with concurrent positive serology for HBV or HCV. The retrospective study identified a small cohort of psoriasis patients who were also positive for HBV or HCV, and that group was further divided into 3 groups: those with HCV infection; those with chronic HBV infection, defined as serologically positive for surface antigen; and those positive for the HBV core antibody, irrespective of surface antibody status. The study also included a systematic literature review.
The results showed that low-risk patients without hepatitis who are seropositive for HBV core antibody only or HCV infection have minimal risk or no additive risk, respectively, for viral reactivation. However, chronic carriers of HBV have about a 14% risk for yearly viral reactivation. The authors conclude that low-risk patients with a history of viral hepatitis may be safely treated with biologics while chronic carriers of HBV need to be carefully evaluated with regards to risk/benefit and should receive concurrent antiviral prophylaxis.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: July 24, 2017
Adapted from the original article.