Objectives Hepatitis B reactivation (HBVr) constitutes a side effect of the treatment of autoimmune rheumatic diseases. Even though HBVr risk of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) and anti-tumor necrosis factor (anti-TNF) agents has long been established, the risk of targeted synthetic (ts)DMARDs and anti-interleukin (anti-IL) agents remains largely unknown. Methods We conducted a SLR (PubMed, Scopus and EMBASE) and metanalysis to examine the HBVr risk for the following: anti-IL17, anti-IL12/23, anti-IL23 and JAK-inhibitors in patients with chronic HBV infection (HBsAg presence or detectable HBV-DNA) and in patients with prior HBV infection (HBcAb-positive and HBsAg-negative). Meta-analysis was performed using both the fixed and random effects method and was conducted using the R computing language. Results Overall, our study revealed a low HBVr risk of < 6% in all agents; the risk was significantly higher for people having chronic compared with those with resolved HBV (14,4% vs 5.1%, respectively p< 0.01). There was no difference among different drugs in the HBVr rates [anti-IL-17: 4% (95% CI: 1–9%), anti-IL-12/IL-23: 2% (95% CI: 0–5%), JAK-inhibitors: 4% (95% CI: 1–8%), anti-IL23: 0%]. Of note, HBVr rate reached 28% in patients with chronic HBV who did not receive anti-viral treatment. For patients with resolved hepatitis the respective percentage was 4.7%. Conclusion Overall, our meta-analysis shows that patients with chronic HBV receiving anti-IL-17, anti-IL-12/23, anti-IL-23 and JAK-inhibitors have significant risk for HBVr, especially if they are not under anti-viral treatment. In contrast, resolved HBV seems to offer minor risk for HBVr even without anti-viral treatment.

中文翻译：

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PsA 患者的乙型肝炎再激活：IL-17、IL-23 和 JAK 抑制剂的 SLR 和荟萃分析


目的 乙型肝炎再激活 (HBVr) 是治疗自身免疫性风湿性疾病的副作用。尽管传统合成疾病缓解抗风湿药物 (csDMARD) 和抗肿瘤坏死因子 (抗 TNF) 药物的 HBVr 风险早已确定，但靶向合成 (ts)DMARD 和抗白细胞介素 (抗 IL) 药物的风险) 代理在很大程度上仍然未知。方法 我们进行了 SLR（PubMed、Scopus 和 EMBASE）和荟萃分析，以检查慢性 HBV 感染患者（存在 HBsAg 或存在 HBsAg 或可检测到的 HBV-DNA）和先前感染 HBV 的患者（HBcAb 阳性和 HBsAg 阴性）。采用固定效应法和随机效应法进行荟萃分析，并使用 R 计算语言进行。结果 总体而言，我们的研究显示所有药物的 HBVr 风险均较低，为 < 6%；与乙型肝炎已治愈的患者相比，慢性乙型肝炎患者的风险显着更高（分别为 14.4% 和 5.1%，p< 0.01）。不同药物的 HBVr 率无差异[抗 IL-17：4%（95% CI：1–9%），抗 IL-12/IL-23：2%（95% CI：0– 5%），JAK 抑制剂：4%（95% CI：1–8%），抗 IL23：0%]。值得注意的是，在未接受抗病毒治疗的慢性乙型肝炎患者中，HBVr 率达到 28%。对于肝炎已治愈的患者，相应百分比为 4.7%。结论 总体而言，我们的荟萃分析表明，接受抗 IL-17、抗 IL-12/23、抗 IL-23 和 JAK 抑制剂治疗的慢性 HBV 患者存在 HBVr 的显着风险，特别是如果他们未接受抗-病毒治疗。相比之下，即使不进行抗病毒治疗，治愈的 HBV 似乎也会带来较小的 HBVr 风险。