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.  Antitumor necrosis factor-alpha (TNF- α ) agents are widely used for treatment of rheumatic and dermatological diseases. We conducted the systematic review and meta-analysis to assess the prevalence of HBV reactivation among patients treated with anti-TNF- α .  Methods and Findings.  A comprehensive literature search of MEDLINE, Scopus, and ISI Web of Knowledge databases was conducted. From 21 studies included in the systematic review, 9 included patients with occult chronic HBV infection and 6 included patients with overt infection while 6 addressed both groups. Based on 10 studies eligible for meta-analysis we report pooled estimate of HBV reactivation of 4.2% (95% CI: 1.4–8.2%,  I   2 : 74.7%). The pooled prevalence of reactivation was 3.0% (95% CI: 0.6–7.2,  I   2 : 77.1%) for patients with occult infection, and 15.4% (95% CI: 1.2–41.2%,  I   2 : 79.9%) for overt infection. The prevalence of reactivation was 3.9% (95% CI: 1.1–8.4%,  I   2 : 51.1%) for treatment with etanercept and 4.6% (95% CI: 0.5–12.5%,  I   2 : 28.7%) for adalimumab. For subgroup of patients without any antiviral prophylaxis the pooled reactivation was 4.0% (95% CI: 1.2–8.3%,  I   2 : 75.6%).  Conclusion.  Although HBV reactivation rate is relatively low in patients treated with anti-TNF- α  for rheumatic and dermatological conditions, the antiviral prophylaxis would be recommended in patients with overt chronic HBV infection.

international journal of rheumatology

HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-<i>α</i>) Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis

HBV Reactivation in Patients Treated with Antitumor Necrosis Factor-Alpha (TNF-α) Agents for Rheumatic and Dermatologic Conditions: A Systematic Review and Meta-Analysis