《Table 4 Hepatitis B risk in Chinese patients treated with biologic agents》

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《Biologic treatments for psoriasis in China: current status and potential tuberculosis and hepatitis B virus risks》

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RS:retrospective study；OLS:Open-label study；RA:rheumatoid arthritis；AS:ankylosing spondyltis；JIA:juvenile idiopathic arthritis；PsA:psoriaticarthritis；LFT:live function test.

In the host defense system，TNF-α，which acts as an important proinflammatory cytokine against pathogenic microorganisms，suppresses HBV replication and results in HBV elimination by promoting HBV-specific cytotoxic T-cell responses.Therefore，antiTNF-αagents can reactivate chronic viral hepatitis，with chronic hepatitis B being a major concern[33].However，data in China on the use of biologic therapy in patients with hepatitis B are limited，particularly in patients with psoriasis.Insights about the risk of reactivated hepatitis B during biologic therapy have mostly been provided by treatment studies on patients with ankylosing spondylitis and rheumatoid arthritis（Table 4）.In one study，fifteen HBVinfected patients with ankylosing spondylitis or rheumatoid arthritis were treated with infliximab[34].Three（20%）of the patients experienced a signifi-cant increase of HBV DNA with 2 developing liver function abnormality 2 to 10 weeks after infliximab treatment.Notably，all of the three patients with an increase in HBV DNA were HBsAg positive.The risk of HBV reactivation upon infliximab treatment in patients with previous exposure to HBV but with negative HBsAg was further evaluated in a retrospective study of 234 patients，all of whom were treated for rheumatoid arthritis[35].Although the average ALT and AST levels of 41 patients with previous exposure to HBV rose slightly from week0 to week 26，they were still within the normal range.Among them，35 patients were anti-HBc positive alone or anti-HBs and anti-HBe positive.