Comparative risk of reactivation of hepatitis B and C after treatment with biologics and targeted synthetic DMARDs in psoriasis and psoriatic arthritis: A 15-year multicenter cohort study

Hsien-Yi Chiu¹, Che-Chia Hsu², Tsen-Fang Tsai², Kuo-Lung Lai³, Sung-Jen Hung⁴, Nan-Lin Wu⁵, Kai Che Wei⁶, Tsu-Man Chiu⁷, Shao-Hsuan Hsu⁸, Ting-Yuan Lan⁹, Chaw-Ning Lee¹⁰, Ying-Ming Chiu¹¹, Rosaline Chung-Yee Hui¹², Ching-Chi Chi¹³, Chun-Bing Chen¹⁴, Chao-Chun Yang¹⁵, I-Lun Tseng¹⁶, Yu-Huei Huang¹⁷

Affiliations

¹ Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Dermatology, School of Medicine, Tzu Chi University, Hualien, Taiwan.
⁵ Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan.
⁶ Department of Dermatology, Veterans General Hospital, Kaohsiung, Taiwan; Department of Cosmetic Applications and Management, Faculty of Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan; Department of Dermatology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
⁹ Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
¹⁰ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Dermatology, Stanford University, Stanford, California; Population Health Data Center, National Cheng Kung University, Tainan, Taiwan.
¹¹ Department of Allergy, Immunology, and Rheumatology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan; Department of Nursing, Jen Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
¹² Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
¹³ Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁴ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
¹⁵ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair & Regeneration, National Cheng Kung University, Tainan, Taiwan.
¹⁶ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁷ Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan. Electronic address: huangyh@adm.cgmh.org.tw.

PMID: 40972765
DOI: 10.1016/j.jaad.2025.09.030

Comparative risk of reactivation of hepatitis B and C after treatment with biologics and targeted synthetic DMARDs in psoriasis and psoriatic arthritis: A 15-year multicenter cohort study

Hsien-Yi Chiu et al. J Am Acad Dermatol. 2025.

. 2025 Sep 17:S0190-9622(25)02814-2.

doi: 10.1016/j.jaad.2025.09.030. Online ahead of print.

Authors

Affiliations

¹ Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Dermatology, School of Medicine, Tzu Chi University, Hualien, Taiwan.
⁵ Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan.
⁶ Department of Dermatology, Veterans General Hospital, Kaohsiung, Taiwan; Department of Cosmetic Applications and Management, Faculty of Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan; Department of Dermatology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Dermatology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
⁹ Division of Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
¹⁰ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Dermatology, Stanford University, Stanford, California; Population Health Data Center, National Cheng Kung University, Tainan, Taiwan.
¹¹ Department of Allergy, Immunology, and Rheumatology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan; Department of Nursing, Jen Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
¹² Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
¹³ Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁴ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
¹⁵ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair & Regeneration, National Cheng Kung University, Tainan, Taiwan.
¹⁶ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁷ Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan. Electronic address: huangyh@adm.cgmh.org.tw.

PMID: 40972765
DOI: 10.1016/j.jaad.2025.09.030

Abstract

Background: The relative risks of HBV reactivation (HBVr) and HCV reactivation (HCVr) associated with different immunosuppressant agents in psoriasis and psoriatic arthritis are unknown.

Objective: We assessed the comparative risks of HBVr and HCVr for patients treated with biologics and targeted synthetic disease-modifying antirheumatic drugs.

Methods: We screened 5,527 treatment episodes (TEs) with available HBV and HCV serology data from 3197 patients who received biologics or targeted synthetic disease-modifying antirheumatic drugs; 1525 eligible TEs (1343 HBV TEs; 182 HCV TEs) were included.

Results: HBVr and HCVr occurred in 143 (10.6%) and 18 (9.9%) of TEs during 2104.5 and 271.2 person-years of follow-up, respectively. The risks of HBVr and HCVr were highest for tumor necrosis factor-α inhibitors, followed by interleukin-12/23 inhibitor (IL-12/23i), IL-17i, and IL-23i. Analysis revealed drug class (tumor necrosis factor-α inhibitors), hepatitis B surface antigen-positivity, hepatitis B e-antigen-positivity, concomitant use of immunosuppressants, and absence of antiviral prophylaxis were significantly associated with HBVr; a higher baseline viral load and drug class (tumor necrosis factor-α inhibitors) were associated with HCVr.

Limitations: Observational design and nonrandom treatment allocation.

Conclusions: The differential risks of HBVr and HCVr should be considered when selecting targeted therapies in psoriasis and psoriatic arthritis, particularly for patients with risk factors for viral reactivation.

Keywords: biologics; hepatitis B; hepatitis C; immunosuppressant; psoriasis; reactivation; tsDMARDs.

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Conflict of interest statement

Conflicts of interest All authors have completed the ICMJE uniform disclosure form available at www.icmje.org/coi_disclosure.pdf and declare the following: Drs Chiu and Hui received speaking fees and received honoraria for serving as an advisory board member from AbbVie, Novartis, Janssen-Cilag, Eli-Lilly, Kyowa Hakko Kirin Taiwan, GlaxoSmithKline, UCB, Boehringer Ingelheim, and Pfizer pharmaceuticals and conducted clinical trials for AbbVie, Eli-Lilly, Sanofi Pharmaceuticals, Janssen-Cilag Pharmaceuticals. Dr Tsai has served as a consultant for Abbvie, AnaptysBio, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli-Lilly, Galderma, GSK, Janssen-Cilag, Leo Pharma, Merck Sharp and Dohme, Novartis International, Pfizer, PharmaEssentia, Sanofi, Sun Pharma and UCB Pharma. Dr Hung has received speaking fees from AbbVie, Novartis, Janssen-Cilag Pharmaceutica, Kyowa Hakko Kirin Taiwan, Pfizer, and Sanofi Pharmaceuticals Corporation. Dr Wu has received speaking fees from AbbVie, Novartis Pharmaceuticals Corporation, Janssen-Cilag Pharmaceutica, Eli-Lilly, Kyowa Hakko Kirin Taiwan, Boehringer Ingelheim Taiwan, UCB Pharmaceuticals (Taiwan) Ltd, and Pfizer Limited and conducted clinical trials for AbbVie, Novartis Pharmaceuticals Corporation, Janssen-Cilag Pharmaceutica, UCB Pharmaceuticals (Taiwan) Ltd, Pfizer Limited, AMGen, and Sanofi. Dr Chiu has received speaking fees from AbbVie, Novartis Pharmaceuticals Corporation, Janssen-Cilag Pharmaceutica, and Pfizer Limited and received honoraria for serving as a consultant for AbbVie, Novartis Pharmaceuticals Corporation, and Janssen-Cilag Pharmaceutica. Dr Hsu have received speaking fees from AbbVie, Eli-Lilly, Janssen-Cilag Pharmaceutica, Kyowa Hakko Kirin Taiwan, Leo Pharma, Novartis Pharmaceuticals Corporation, and Sanofi. Dr Chen has received speaking fees from AbbVie, Novartis Pharmaceuticals Corporation, Janssen-Cilag Pharmaceutica, Eli-Lilly, Kyowa Hakko Kirin Taiwan, Pfizer Limited and Sanofi, and conducted clinical trials or received honoraria for serving as a consultant for Novartis Pharmaceuticals Corporation, Eli-Lilly and Sanofi. Dr Yang has served as a consultant for Abbvie, Boehringer Ingelheim, Eli-Lilly, GSK, Janssen, Novartis, Pfizer and Sanofi. Dr Huang has conducted clinical trials for serving as a principal investigator for Galderma, Eli-Lilly, Novartis Pharmaceuticals Corporation, and Janssen-Cilag Pharmaceutica; received honoraria for serving as an advisory board member for Pfizer Limited, AbbVie, and Celgene; and received speaking fees from AbbVie, Eli-Lilly, and Novartis Pharmaceuticals Corporation. Drs Chia Hsu, Wei, Lan, Lee, Mong Chiu, Chi, Tseng, and Lai have no conflicts of interest to declare.

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Comparative risk of reactivation of hepatitis B and C after treatment with biologics and targeted synthetic DMARDs in psoriasis and psoriatic arthritis: A 15-year multicenter cohort study

Affiliations

Comparative risk of reactivation of hepatitis B and C after treatment with biologics and targeted synthetic DMARDs in psoriasis and psoriatic arthritis: A 15-year multicenter cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

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