Search

Resumen Introduccion y objetivos Se ha reportado un riesgo de reactivacion de hepatitis B pasada de hasta el 5% en pacientes tratados con farmacos dirigidos contra el factor de necrosis tumoral para enfermedades distintas a la psoriasis. Nuestro objetivo es investigar el riesgo de reactivacion del virus de la hepatitis B en pacientes con hepatitis B pasada y psoriasis tratada con biologicos. Material y metodos Estudio multicentrico en el que se incluyeron 20 pacientes con serologia sugestiva de hepatitis B pasada (antiHBc+, antigeno HBs–) y diagnostico de psoriasis tratada con al menos un biologico. Se recogieron variables clinicas, serologicas y de funcion hepatica antes, durante y al final del seguimiento. Se obtuvo una carga viral al final del seguimiento en todos los pacientes. Resultados Ningun paciente mostro criterios de reactivacion de hepatitis B al final del estudio, con una mediana de seguimiento de 40 meses. Sumando los datos de otras series publicadas de pacientes con psoriasis y hepatitis B pasada tratados con biologicos, el riesgo maximo seria de 2,7 reactivaciones por 100 pacientes tratados con un seguimiento medio de unos 30 meses. Conclusiones En nuestro estudio el tratamiento con biologicos no provoco ninguna reactivacion de hepatitis B. Sin embargo, debido a las graves complicaciones asociadas a la misma, se aconseja descartar portadores ocultos en pacientes con hepatitis B pasada antes de iniciar tratamiento biologico (solicitando una carga viral al inicio del mismo), asi como un seguimiento conjunto con un hepatologo.

A 5% risk of reactivation of hepatitis B virus (HBV) infection has been reported in patients with diseases other than psoriasis treated with tumor necrosis factor inhibitors. The aim of this study was to investigate the risk of HBV reactivation in patients with a past history of HBV infection who were receiving biologic therapy for psoriasis.This was a multicenter study of 20 patients with psoriasis who were treated with at least 1 biologic agent. All the patients had serologic evidence of past HBV infection (positive total hepatitis B core antibody and negative hepatitis B surface antibody). We analyzed the clinical, serological, and liver function variables recorded before, during, and at the end of follow-up. The viral load at the end of follow-up was also analyzed for all patients.None of the patients fulfilled the criteria for HBV reactivation at the end of a median follow-up period of 40 months. Combining our data with data from other studies of psoriasis patients with a past history of HBV infection who were treated with a biologic, we calculated a maximum estimated risk of HBV reactivation for a mean follow-up period of 30 months of 2.7 reactivations per 100 patients.Biologic therapy did not cause HBV reactivation in our series of patients. Nonetheless, because of the potentially serious complications associated with HBV reactivation, it is important to measure viral load in patients with a history of HBV infection prior to initiation of biologic therapy to rule out occult carriage. These patients should also be monitored regularly in conjunction with a hepatologist.