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Hepatitis B reactivation in psoriasis patients treated with anti-TNF agents: prevention and management

Authors Cannizzaro MV, Franceschini C, Esposito M, Bianchi L, Giunta A

Received 22 November 2016

Accepted for publication 6 March 2017

Published 15 April 2017 Volume 2017:7 Pages 35—40


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Uwe Wollina

Maria Vittoria Cannizzaro, Chiara Franceschini, Maria Esposito, Luca Bianchi, Alessandro Giunta

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy

The risk of hepatitis B virus (HBV) reactivation (HBVr) in chronic HBV carriers, in occult HBV patients or in acute HBV patients affected by psoriasis and treated with anti-tumor necrosis factor (TNF)-α agents is a clinical practice issue to face with, particularly if the treatment has a long-term maintenance finality. The aims of this review are to examine the current knowledge on HBVr incidence in chronic HBV carriers and potential occult carriers undergoing therapy with biologics for the treatment of psoriasis and psoriatic arthritis; analyze the prophylactic measure to prevent HBV reactivation and define how to manage HBVr in patients treated with biologics. We searched through PubMed, Google Scholar and Scopus databases and evaluated all published manuscripts concerning HBVr in psoriatic patients, both plaque-type and psoriatic arthritis, in treatment with any indicated anti-TNF-α. Although anti-TNFs are considered moderate immunosuppressive drugs, the incidence of HBVr in psoriatic patients is lower compared to patients affected by other immune-mediated diseases treated with TNF inhibitors. HBV prophylaxis should be probably reserved to anti-HBs+/anti-HBc+ patients with a viral load <2000 IU/mL and alterations in serum liver enzymes, in order to prevent HBVr.

HBV reactivation, anti-TNF-α, psoriasis, immune-mediated diseases, HBV reactivation prevention, biologics

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