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

Introduction.Antitumor necrosis factor-alpha (TNF-α) 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-α.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%,I2: 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6–7.2,I2: 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2–41.2%,I2: 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1–8.4%,I2: 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5–12.5%,I2: 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.2–8.3%,I2: 75.6%).Conclusion.Although HBV reactivation rate is relatively low in patients treated with anti-TNF-αfor rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection.

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CME Exam 3: Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis

Gastroenterology ◽

10.1053/j.gastro.2019.01.019 ◽

2019 ◽

Vol 156 (3) ◽

pp. e18

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Hbv Infection ◽

Chronic Hbv Infection ◽

Factors Associated ◽

Hbsag Seroclearance ◽

Chronic Hbv

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Polymorphisms of Tumor Necrosis Factor-Alpha and Hepatocellular Carcinoma Risk: A HuGE Systematic Review and Meta-Analysis

Digestive Diseases and Sciences ◽

10.1007/s10620-011-1617-y ◽

2011 ◽

Vol 56 (8) ◽

pp. 2227-2236 ◽

Cited By ~ 33

Author(s):

Yonggang Wei ◽

Fei Liu ◽

Bo Li ◽

Xi Chen ◽

Yu Ma ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Tumor Necrosis Factor ◽

Tumor Necrosis Factor Alpha ◽

Tumor Necrosis ◽

Meta Analysis ◽

Necrosis Factor Alpha ◽

Factor Alpha ◽

Carcinoma Risk ◽

Necrosis Factor

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Hepatitis B reactivation in patients with solid tumors: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.138 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 138-138 ◽

Cited By ~ 2

Author(s):

Lisa K. Hicks ◽

Jordan J. Feld ◽

Ronak Saluja ◽

Judy Truong ◽

Adam E. Haynes ◽

...

Keyword(s):

Systematic Review ◽

Hepatitis B ◽

Solid Tumors ◽

Solid Tumor ◽

Odds Ratio ◽

Meta Analysis ◽

Hbv Reactivation ◽

Antiviral Prophylaxis ◽

Chronic Hbv ◽

The Impact

138 Background: Hepatitis B virus (HBV) affects over 250 million people worldwide. Most people with chronic HBV (HBsAg positive) have no signs or symptoms of infection. However, when exposed to immunosuppression they are at risk of HBV reactivation which can cause hepatitis, liver failure and death. The risk of HBV reactivation in patients receiving chemotherapy for solid tumors, the efficacy of antiviral prophylaxis, and the clinical impact of HBV reactivation in this setting are uncertain. Primary Aim: To estimate the risk of clinical HBV reactivation (increased HBV DNA + transaminitis) among HBsAg-positive patients administered chemotherapy for a solid tumor. Secondary Aims: To estimate the efficacy of anti-viral prophylaxis and the risk of death from HBV reactivation in patients receiving chemotherapy for solid tumors. Methods: A systematic review and meta-analysis of the English language literature on HBV reactivation was completed (OVID Medline, 1946 to Aug 2013). All citations were reviewed by two or more authors. Data from patients with hematologic malignancies were excluded. Pooled probabilities of HBV reactivation risk, death from HBV reactivation, and odds ratio for the impact of anti-viral prophylaxis were estimated with a random effects model. Results: 2,667 citations were identified; 19 were eligible for inclusion. The pooled estimate for clinical HBV reactivation in HBsAg-positive patients receiving chemotherapy for a solid tumor was 21.9% (95% CI; 16.5% to 27.3%) in those not receiving anti-viral prophylaxis, and 2.4% (95% CI 0.7% to 4.2%) in those receiving anti-viral prophylaxis. The odds ratio for clinical HBV reactivation with antiviral prophylaxis compared to no prophylaxis was 0.12 (95% CI 0.06 to 0.25). In the absence of viral prophylaxis, the risk of dying from HBV reactivation in HBsAg-positive solid tumor patients was estimated at 1.3% with a 95% CI of 0.3% to 2.3%. Conclusions: Patients with chronic HBV who are administered chemotherapy for a solid tumor appear to be at substantial risk of clinical HBV reactivation; this risk may be mitigated by anti-viral prophylaxis. In the absence of anti-viral therapy, patients may experience a small but important risk of dying from HBV reactivation.

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