Liver international : official journal of the International Association for the Study of the Liver · 2026
TNF-α Inhibitors and HBV Reactivation Risk in HBsAg-/Anti-HBc+ Patients: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Kuo Meng Hsuan, Ko Ping-Hung, Lee Chen-Chou, Tseng Chih-Wei
Аннотация
BACKGROUND: Tumour necrosis factor-α (TNF-α) inhibitors are integral in the treatment of immune-mediated inflammatory diseases but may precipitate hepatitis B virus reactivation (HBVr) in HBsAg-/anti-HBc+ patients. APASL guidance presumes a greater risk with higher-potency agents, but the evidence is limited and conflicting. We conducted a systematic review and meta-analysis to assess whether TNF-α inhibitor potency alters HBVr risk in HBsAg-/anti-HBc+ individuals and to identify predictors.
METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on May 29, 2025. Eligible cohort studies and randomised trials reported HBVr under TNF-α inhibitor treatment in HBsAg-/anti-HBc+ patients. The risk of bias was assessed via the Newcastle-Ottawa Scale and the RoB 2.0. Random-effects meta-analysis was used to pool the HBV incidence and risk ratios (RRs), and subgroup analyses were used to explore heterogeneity.
RESULTS: Thirteen cohorts (1492 patients) reported 37 HBVr events, yielding a pooled incidence of 2.3% (95% CI 1.1%-4.8%; I2 = 56%). The incidence was 3.9% (95% CI 2.1%-7.0%; I2 = 34%) with high-potency agents and 3.6% (95% CI 2.2%-5.8%; I2 = 0%) with low-potency agents. High- and low-potency TNF-α inhibitors were associated with comparable HBVr risk (RR 0.92, 95% CI 0.47-1.79; I2 = 0%). Agent-specific incidences ranged from 3.6% to 5.4%, without significant differences compared with etanercept. Anti-HBs seronegativity conferred a greater risk (incidence, 8.2% vs. 3.1%; RR 2.77, 95% CI 1.42-5.39). The reactivation risk did not vary by geography, age, indication, follow-up, design, or bias rating.
CONCLUSION: In HBsAg-/anti-HBc+ patients, TNF-α inhibitor potency did not significantly alter the already low risk of HBVr. Continued surveillance is warranted, particularly in anti-HBs-negative individuals.
TRIAL REGISTRATION: INPLASY202570100.
METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on May 29, 2025. Eligible cohort studies and randomised trials reported HBVr under TNF-α inhibitor treatment in HBsAg-/anti-HBc+ patients. The risk of bias was assessed via the Newcastle-Ottawa Scale and the RoB 2.0. Random-effects meta-analysis was used to pool the HBV incidence and risk ratios (RRs), and subgroup analyses were used to explore heterogeneity.
RESULTS: Thirteen cohorts (1492 patients) reported 37 HBVr events, yielding a pooled incidence of 2.3% (95% CI 1.1%-4.8%; I2 = 56%). The incidence was 3.9% (95% CI 2.1%-7.0%; I2 = 34%) with high-potency agents and 3.6% (95% CI 2.2%-5.8%; I2 = 0%) with low-potency agents. High- and low-potency TNF-α inhibitors were associated with comparable HBVr risk (RR 0.92, 95% CI 0.47-1.79; I2 = 0%). Agent-specific incidences ranged from 3.6% to 5.4%, without significant differences compared with etanercept. Anti-HBs seronegativity conferred a greater risk (incidence, 8.2% vs. 3.1%; RR 2.77, 95% CI 1.42-5.39). The reactivation risk did not vary by geography, age, indication, follow-up, design, or bias rating.
CONCLUSION: In HBsAg-/anti-HBc+ patients, TNF-α inhibitor potency did not significantly alter the already low risk of HBVr. Continued surveillance is warranted, particularly in anti-HBs-negative individuals.
TRIAL REGISTRATION: INPLASY202570100.