Hepatitis B reactivation with TNF-α inhibitors: assessing antiviral prophylaxis efficacy — protocol for systematic review and meta-analysis

The rate of hepatitis B virus (HBV) reactivation varies greatly between chronic and occult carrier states. Despite established practice standards, high-risk individuals still get insufficient preventative antiviral treatment. Current recommendations propose prophylactic nucleoside/nucleotide analogue (NA) prophylaxis for immunosuppressive treatment that has a high risk of reactivating HBV. For low-risk treatments, on-demand NA treatment is recommended. For intermediate-risk drugs, either strategy might be suitable. However, there is an urgent need for agreement on standardized criteria and reporting protocols for HBV reactivation in the setting of immunosuppressive treatments. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42024548106.