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5PSQ-001 Incidence of hepatitis B virus reactivation in psoriasis patients treated with cytokine inhibitors: a systematic review and meta-analysis
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  1. SC Shao1,
  2. MH Kuo2,
  3. CW Tseng3
  1. 1Keelung Chang Gung Memorial Hospital, Department of Pharmacy, Keelung, Taiwan R.O.C
  2. 2Dalin Tzu Chi Hospital, Department of Pharmacy, Chiayi, Taiwan R.O.C
  3. 3Dalin Tzu Chi Hospital, Division of Gastroenterology- Department of Internal Medicine, Chiayi, Taiwan R.O.C

Abstract

Background and Importance The safety of cytokine inhibitors in psoriasis patients with hepatitis B virus (HBV) remains uncertain due to their exclusion from clinical trials. Observational studies have recently raised clinical concerns about HBV reactivation (HBVr) risk in psoriasis patients using cytokine inhibitors, but a comprehensive systematic review is still lacking.

Aim and Objectives This study aimed to evaluate the risks of HBVr in psoriasis patients treated with cytokine inhibitors.

Material and Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a systematic literature search in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for relevant observational studies on 5 May 2023. We included studies with >5 cases and complete HBV status. Two independent reviewers performed the study selection and data extraction, and the discrepancies between reviewers would be solved by the full discussion. A random-effects meta-analysis assessed the pooled incidence of HBVr. We also conducted subgroup analyses to compare HBVr incidence across different cytokine inhibitors and HBsAb status.

Results Eight observational studies comprising 181 psoriasis patients were included. Among HBsAg+ individuals without antiviral prophylaxis, the pooled HBVr incidence was 25.3% (95% CI: 10.4 to 49.7%) with a median onset at 5 months (range: 3–7 months) from the cytokine inhibitor initiation. No HBVr events were observed in HBsAg+ individuals with antiviral prophylaxis. Among HBsAg−/HBcAb+ individuals, the pooled HBVr incidence was 5.0% (95% CI: 2.3 to 10.8%) with a median onset at 12 months from the cytokine inhibitor initiation. Subgroup analysis showed similar pooled HBVr incidence for IL-12/23 inhibitors (4.0%, 95% CI: 1.3 to 11.8%), IL-17 inhibitors (6.6%, 95% CI: 1.9 to 20.5%), and IL-23 inhibitors (5.0%, 95% CI: 0.3 to 47.5%). No significant risk difference was found between patients with and without HBsAb (risk difference: −0.01%; 95% CI −0.16 to 0.13%).

Conclusion and Relevance This systematic review and meta-analysis shed light on the incidence of HBVr associated with cytokine inhibitors in psoriasis patients. Prophylactic antiviral use is crucial for patients with HBV. Physicians and pharmacists must ensure proper HBV protection through prophylaxis and monitoring when administering cytokine inhibitors, in addition to adhering to recommended HBV vaccination.

Conflict of Interest No conflict of interest.

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