Some therapies for psoriasis, PSA linked to HBV, HCV reactivation

A 15-year study recommends taking into consideration the differential risks of hepatitis B virus (HBV) and hepatitis C virus (HCV) reactivations when choosing targeted therapies for the treatment of psoriasis and psoriatic arthritis (PsA), particularly in patients with risk factors for viral reactivation.

The investigators enrolled 3,197 patients who received biologics or targeted synthetic disease-modifying antirheumatic drugs in this multicentre cohort study. They then screened a total of 5,527 treatment episodes (TEs) with available HBV and HCV serology data. Of these, 1,525 (1,343 HBV TEs and 182 HCV TEs) were eligible for analysis.

Reactivations of HBV and HCV occurred in 143 (10.6 percent) and 18 (9.9 percent) of TEs during 2,104.5 and 271.2 person-years of follow-up, respectively. The highest reactivation risks were observed in tumour necrosis factor-α inhibitors (TNFi), followed by interleukin (IL)-12/23 inhibitor, IL-17 inhibitor, and IL-23 inhibitor.

In further analysis, HBV reactivation significantly correlated with drug class (ie, TNFi), hepatitis B surface antigen-positivity, hepatitis B e-antigen-positivity, concomitant use of immunosuppressants, and absence of antiviral prophylaxis. On the other hand, HCV reactivation was significantly associated with a higher baseline viral load and drug class (ie, TNFi).

This study was limited by its observational design and nonrandom treatment allocation, according to the investigators.