title: HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-α) Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis.
abstract: 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%, I (2): 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6-7.2, I (2): 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2-41.2%, I (2): 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1-8.4%, I (2): 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5-12.5%, I (2): 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.2-8.3%, I (2): 75.6%). Conclusion. Although HBV reactivation rate is relatively low in patients treated with anti-TNF-α for rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection.
authors.affiliation: Division of Rheumatology, Misericordia e Dolce Hospital, Via Cavour 87/89, 59100 Prato, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cantini
authors.affiliation: Section of Hygiene, Institute of Public Health, Department of Public Health, Università Cattolica del Sacro Cuore, L.go F.Vito 1, 00168 Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Boccia
authors.affiliation: Translational Research Unit, Department of Epidemiology and Preclinical Research, INMI, Via Portuense 292, 00149 Rome, Italy.
authors.forename: Delia
authors.identifier: 0000-0001-8360-4376
authors.initials: D
authors.lastname: Goletti
authors.affiliation: Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, Piazza Giulio Cesare 1, 70124 Bari, Italy.
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.affiliation: Section of Hygiene, Institute of Public Health, Department of Public Health, Università Cattolica del Sacro Cuore, L.go F.Vito 1, 00168 Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Leoncini
authors.affiliation: Section of Hygiene, Institute of Public Health, Department of Public Health, Università Cattolica del Sacro Cuore, L.go F.Vito 1, 00168 Rome, Italy.
authors.forename: Nikola
authors.identifier: 0000-0002-5930-9884
authors.initials: N
authors.lastname: Panic
authors.affiliation: Dermatology Clinic/ASF Department of Surgery and Translational Medicine, University of Florence, Via Lorenzo Il Magnifico 104, 50129 Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Prignano
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Second University of Naples, Via S. Pansini 5, 80131 Naples, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Gaeta
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