From the Medical Board of the National Psoriasis Foundation: Recommendations for screening for hepatitis B infection prior to initiating anti-tumor necrosis factor-alfa inhibitors or other immunosuppressive agents in patients with psoriasis.
BACKGROUND
No consensus exists regarding the optimal laboratory screening for hepatitis B infection that should be performed before initiating therapy with tumor necrosis factor-alfa inhibitors or other immunosuppressive agents.


OBJECTIVE
We sought to give guidelines on which tests to order for hepatitis B screening.


METHODS
We review the pathophysiology and serology of hepatitis B infection and provide recommendations for screening for hepatitis B infection in patients with psoriasis before beginning anti-tumor necrosis factor-alfa therapy or other immunosuppressive agents.


RESULTS
We propose the standardized use of triple serology testing: hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody in combination with liver function tests as screening.


CONCLUSIONS
Conclusions based on review of available literature is a limitation.


CONCLUSIONS
All patients with psoriasis who are candidates for tumor necrosis factor-alfa inhibitor should undergo screening for hepatitis B virus infection using the triple serology: hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. It is advisable that patients, who are candidates for ustekinumab, cyclosporine, or methotrexate undergo the same screening.
Department of Dermatology, Baylor College of Medicine, Houston, Texas.
Kiran
K
Motaparthi
Department of Dermatology, Baylor College of Medicine, Houston, Texas.
Vladimir
V
Stanisic
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Abby S
AS
Van Voorhees
Mount Sinai School of Medicine, New York, New York.
Mark G
MG
Lebwohl
Department of Dermatology, Baylor College of Medicine, Houston, Texas. Electronic address: shsu@bcm.edu.
Sylvia
S
Hsu
D006509:Hepatitis B / Q000097:blood* / Q000175:diagnosis*; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008111:Liver Function Tests; D011565:Psoriasis / Q000097:blood* / Q000188:drug therapy*; D012698:Serologic Tests; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
AAD; ALT; American Academy of Dermatology; CDC; Centers for Disease Control and Prevention; CsA; HBV; HBcAb; HBcIgM; HBeAb; HBeAg; HBsAb; HBsAg; HCC; LFT; MTX; TNF; TNFI; alanine aminotransferase; anti–tumor necrosis factor-alfa; biologic therapy; cyclosporine; hepatitis B; hepatitis B core IgM antibody; hepatitis B core antibody; hepatitis B core e antibody; hepatitis B core e antigen; hepatitis B surface antibody; hepatitis B surface antigen; hepatitis B virus; hepatocellular carcinoma; liver function test; methotrexate; psoriasis; tumor necrosis factor; tumor necrosis factor-alfa inhibitor; ustekinumab