Comparative risk of reactivation of hepatitis B and C after treatment with biologics and targeted synthetic DMARDs in psoriasis and psoriatic arthritis: A 15-year multicenter cohort study

Background The relative risks of HBV reactivation (HBVr) and HCV reactivation (HCVr) associated with different immunosuppressant agents in psoriasis and psoriatic arthritis are unknown. Objective We assessed the comparative risks of HBVr and HCVr for patients treated with biologics and targeted synthetic disease-modifying antirheumatic drugs. Methods We screened 5,527 treatment episodes (TEs) with available HBV and HCV serology data from 3197 patients who received biologics or targeted synthetic disease-modifying antirheumatic drugs; 1525 eligible TEs (1343 HBV TEs; 182 HCV TEs) were included. Results HBVr and HCVr occurred in 143 (10.6%) and 18 (9.9%) of TEs during 2104.5 and 271.2 person-years of follow-up, respectively. The risks of HBVr and HCVr were highest for tumor necrosis factor-α inhibitors, followed by interleukin-12/23 inhibitor (IL-12/23i), IL-17i, and IL-23i. Analysis revealed drug class (tumor necrosis factor-α inhibitors), hepatitis B surface antigen-positivity, hepatitis B e-antigen-positivity, concomitant use of immunosuppressants, and absence of antiviral prophylaxis were significantly associated with HBVr; a higher baseline viral load and drug class (tumor necrosis factor-α inhibitors) were associated with HCVr. Limitations Observational design and nonrandom treatment allocation. Conclusions The differential risks of HBVr and HCVr should be considered when selecting targeted therapies in psoriasis and psoriatic arthritis, particularly for patients with risk factors for viral reactivation.