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

J Am Acad Dermatol. 2014 Jan;70(1):178-86. doi: 10.1016/j.jaad.2013.08.049. Epub 2013 Nov 9.

Abstract

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.

Limitations: 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.

Keywords: 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.

Publication types

  • Practice Guideline

MeSH terms

  • Hepatitis B / blood*
  • Hepatitis B / diagnosis*
  • Hepatitis B Antibodies / blood
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B Surface Antigens / immunology
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Liver Function Tests
  • Psoriasis / blood*
  • Psoriasis / drug therapy*
  • Serologic Tests
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha