HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-alpha)Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis

Introduction. Antitumor necrosis factor-alpha (TNF-alpha) agents are widely used for treatment of rheumatic and dermatological diseases. We conducted the systematic review and meta-analysis to assess the prevalence of HBV reactivation among patients treated with anti-TNF-alpha. Methods and Findings. A comprehensive literature search of MEDLINE, Scopus, and ISI Web of Knowledge databases was conducted. From 21 studies included in the systematic review, 9 included patients with occult chronic HBV infection and 6 included patients with overt infection while 6 addressed both groups. Based on 10 studies eligible for meta-analysis we report pooled estimate of HBV reactivation of 4.2% (95% CI: 1.4-8.2%,I-2 : 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6-7.2,I-2 : 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2-41.2%,I-2 : 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1-8.4%,I-2 : 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5-12.5%,I-2 : 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.28.3%,I-2 : 75.6%). Conclusion. Although HBV reactivation rate is relatively low in patients treated with anti-TNF-alpha for rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection.