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Background:
Tumor necrosis factor inhibitory agents are currently considered to be contraindicated in psoriatic patients with *hepatitis B.
Objective:
We aim to provide guidance to dermatologists on the use of tumor necrosis factor inhibitor therapy in these patients.
Methods:
The current literature was reviewed regarding the use of tumor necrosis factor-alpha inhibitory agents Atanercept (Enbrel), Adalimumab (Humire), and Infliximab (Remicade) in psoriatic patients with particular reference to hepatitis B infection.
Results:
Tumor necrosis factor-alpha inhibitor therapy may result in reactivated hepatitis B in hepatitis B surface antigen-positive patients with psoriasis. This also occurs, although less frequently in patients with an isolated positive hepatitis B core antibody. Thus, all psoriasis patients should be screened for hepatitis B surface antigen plus hepatitis B core antibody prior to the initiation of tumor necrosis factor-alpha inhibitor therapy. Infliximab (Remicade) has been associated with more reactivation cases than the other 2 agents and fatalities have been reported with this agent. Evidence is presented that the risk of reactivation can be greatly minimized or eliminated by early or pre-emptive antiviral therapy.
Limitations:
The data is largely based on small case series that are retrospective in nature.
Conclusions:
Hepatitis B screening is essential prior to the initiation of tumor necrosis factor-alpha inhibitor therapy. Psoriatic patients found to be hepatitis B surface antigen or hepatitis B core antibody-positive should be referred to an appropriate specialist for evaluation and therapy. This would allow for the safe use of tumor necrosis factor-alpha inhibitors in psoriatic patients despite recently published guidelines to the contrary.
Source: eblue.org
*Hepatitis B is an infectious inflammatory illness of the liver and causes liver inflammation, vomiting, jaundice and, rarely, death.
Tumor necrosis factor inhibitory agents are currently considered to be contraindicated in psoriatic patients with *hepatitis B.
Objective:
We aim to provide guidance to dermatologists on the use of tumor necrosis factor inhibitor therapy in these patients.
Methods:
The current literature was reviewed regarding the use of tumor necrosis factor-alpha inhibitory agents Atanercept (Enbrel), Adalimumab (Humire), and Infliximab (Remicade) in psoriatic patients with particular reference to hepatitis B infection.
Results:
Tumor necrosis factor-alpha inhibitor therapy may result in reactivated hepatitis B in hepatitis B surface antigen-positive patients with psoriasis. This also occurs, although less frequently in patients with an isolated positive hepatitis B core antibody. Thus, all psoriasis patients should be screened for hepatitis B surface antigen plus hepatitis B core antibody prior to the initiation of tumor necrosis factor-alpha inhibitor therapy. Infliximab (Remicade) has been associated with more reactivation cases than the other 2 agents and fatalities have been reported with this agent. Evidence is presented that the risk of reactivation can be greatly minimized or eliminated by early or pre-emptive antiviral therapy.
Limitations:
The data is largely based on small case series that are retrospective in nature.
Conclusions:
Hepatitis B screening is essential prior to the initiation of tumor necrosis factor-alpha inhibitor therapy. Psoriatic patients found to be hepatitis B surface antigen or hepatitis B core antibody-positive should be referred to an appropriate specialist for evaluation and therapy. This would allow for the safe use of tumor necrosis factor-alpha inhibitors in psoriatic patients despite recently published guidelines to the contrary.
Source: eblue.org
*Hepatitis B is an infectious inflammatory illness of the liver and causes liver inflammation, vomiting, jaundice and, rarely, death.