Risk of HBV Reactivation During Immunosuppressive Therapy in Psoriasis: A Retrospective Analysis

Objectives: This study aimed to evaluate the risk of hepatitis B virus (HBV) reactivation in patients with a history of resolved HBV infection or isolated anti-HB core immunoglobulin G positivity who received systemic immunosuppressive therapy for psoriasis.Materials and Methods: A retrospective analysis was conducted on patients 18 years old with psoriasis who received systemic immunosuppressive therapy (3 months), including methotrexate (MTX), apremilast, cyclosporine, and various biologic agents [tumor necrosis factor-alpha, interleukin (IL)-17, IL-23, IL-12/23 inhibitors] between January 2018 and March 2025.Patients with baseline HBV-DNA positivity, human immunodeficiency virus/ hepatitis C virus co-infection, or incomplete data were excluded.HBV reactivation was defined as either HB surface antigen (HBsAg) seroconversion or detectable HBV-DNA.Patients were classified into three risk groups based on serological status and immunosuppressive regimen.Anti-HBs levels were categorized (<10 IU/L, 10-99 IU/L, and 100 IU/L), and risk factors were analyzed using Fisher's exact test and logistic regression.Results: Among 1200 patients screened, 138 eligible individuals were included (63.0% male; mean age 56.911.8years).Seven patients (5.0%) experienced HBV reactivation during immunosuppressive therapy, with no cases of acute hepatitis.Reactivation occurred significantly more often in HBsAg-positive and anti-HBs-negative individuals (p=0.008 and p=0.018, respectively).No reactivation was observed in patients with anti-HBs 10 IU/L (p<0.001).Logistic regression showed a trend toward higher reactivation risk with HBsAg positivity (odds ratio: Z Ama: Bu almada, geirilmi hepatit B virs (HBV) veya izole HB ekirdek antijenine kar gelimi immnoglobulin G antikor pozitiflii olan ve sedef hastal nedeniyle sistemik immnospresif tedavi alan hastalarda HBV reaktivasyon riski deerlendirildi.Gere ve Yntemler: Ocak 2018-Mart 2025 tarihleri arasnda, 18 ya ve zerindeki psoriazis hastalar retrospektif olarak incelendi.En az aydr sistemik immnospresif tedavi metotreksat (MTX), apremilast, siklosporin veya biyolojik ajanlar [tmr nekroz faktr (TNF)-alfa, interlkin (IL)-17, IL-23, IL-12/23 inhibitr] alan hastalar dahil edildi.Balangta HBV-DNA pozitif olanlar, insan baklk yetmezlik virs/hepatit C virs ko-enfeksiyonu bulunanlar ve eksik kaytl hastalar alma d brakld.HBV reaktivasyonu, hepatit B yzey antijeni (HBsAg) serokonversiyonu veya llebilir dzeyde HBV-DNA tespiti olarak tanmland.Hastalar serolojik profilleri ve tedavi rejimlerine gre risk grubuna ayrld.Anti-HBs dzeyleri (<10 IU/L, 10-99 IU/L ve 100 IU/L), ayr ayr deerlendirildi.Risk faktrleri Fisher'n kesin testi ve lojistik regresyon analizi ile incelendi.Bulgular: