%0 Journal Article
%T HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-汐) Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis
%A Fabrizio Cantini
%A Stefania Boccia
%A Delia Goletti
%A Florenzo Iannone
%A Emanuele Leoncini
%A Nikola Panic
%A Francesca Prignano
%A Giovanni Battista Gaeta
%J International Journal of Rheumatology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/926836
%X Introduction. Antitumor necrosis factor-alpha (TNF-汐) 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-汐. 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每8.2%, : 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6每7.2, : 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2每41.2%, : 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1每8.4%, : 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5每12.5%, : 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.2每8.3%, : 75.6%). Conclusion. Although HBV reactivation rate is relatively low in patients treated with anti-TNF-汐 for rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection. 1. Introduction Antitumor necrosis factor-alpha (TNF-汐) agents are widely used for effective treatment of autoimmune rheumatic and dermatological diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (SA), psoriasis (Ps), or psoriatic arthritis (PsA). Nevertheless, anti-TNF-汐 agents have been associated with growing number of adverse events, particularly infections [1, 2] of which some can be life threatening. TNF-汐 is an important proinflammatory cytokine in the host defense mechanism against many intracellular pathogens. It suppresses hepatitis B virus (HBV) replication and promotes HBV eradication by stimulating HBV-specific cytotoxic T-cell response [3每5]. It has been reported that reactivation of HBV infection may occur directly due to lack of TNF-汐 or indirectly via diminishing T-cell activation [6, 7]. TNF-汐 inhibitors are therefore likely to induce HBV replication and reactivation in cases when chronic infection is present. HBV is regarded as a leading cause of acute hepatitis, cirrhosis, and hepatocellular carcinoma [8], being responsible for about 600000 deaths every year [8]. Chronic HBV infection is defined as an overt when hepatitis B surface antigen (HBsAg) is
%U http://www.hindawi.com/journals/ijr/2014/926836/