Hepatitis B Virus Reactivation in Patients with Psoriasis on Biologic Therapies: A Retrospective Study

Background: There are limited data on the safety of biological therapies in psoriasis patients with hepatitis B virus (HBV) infection in the literature, and are still ongoing controversies about HBV reactivation in patients treated with biologics for psoriasis. Aims: This was aimed to investigate the demographic, clinical, and laboratory characteristics of the patients with HBV seropositive receiving biological treatment for psoriasis. Study Design: This was a retrospective observational study. Materials and Methods: Ninety-seven patients with psoriasis treated with biologics in the outpatient clinic were evaluated retrospectively. Of these, 16 patients with HBV seropositive were included in the study. Patients with positive HBV serology were divided into three groups as chronic HBV infection, past HBV infection, and isolated core antibody positivity (HBV core-specific antibody [HBcAb]). The demographic, clinical, and laboratory characteristics of the patients were obtained from the records. Results: Of the patients, 5 patients were female (31.2%), and 11 were male (68.8%). The mean age of the patients was 55.81 +/- 11.05. Thirteen of the patients had past HBV infection, three had isolated HBcAb positive. Infliximab (n = 13) was the most common biologic agent used, followed by adalimumab (n = 6), secukinumab (n = 4), ustekinumab (n = 2), and etanercept (n = 2). The mean duration of treatment was 3.59 +/- 2.76 years. The HBV reactivation occurred in only one patient with past HBV infection receiving infliximab (6.2%). Conclusion: It remains unclear how exactly the biologic drugs for psoriasis impact viral reactivation. For the safe use of biological agents in psoriasis patients with HBV seropositive, screening tests must be performed with a triple serology, including HBV surface antigen, HBV surface-specific antibody, and HBcAb. The patients who have positive HBV serology must be monitored closely with reactivation markers and receive antiviral prophylaxis if they are at moderate-to-high risk of HBV reactivation.