Hepatitis B and Biologics — SCE Dermatology MCQ
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Correct answer: D — Antiviral prophylaxis (e.g. Entecavir or Tenofovir) should be co-prescribed with the biologic to prevent HBV reactivation, with close monitoring of HBV DNA and liver function
Hepatitis B carriers (HBsAg+) starting immunosuppressive/biologic therapy are at risk of HBV reactivation, which can cause fulminant hepatic failure and death. BAD guidelines mandate: pre-treatment HBV assessment (HBsAg, anti-HBc, anti-HBs, HBV DNA, LFTs), antiviral prophylaxis with Entecavir or Tenofovir starting before the biologic and continuing for ≥12 months after cessation, regular monitoring of HBV DNA and liver function, and gastroenterology/hepatology co-management. Anti-TNF biologics carry the highest reactivation risk; IL-17 and IL-23 inhibitors have lower but not negligible risk. Past HBV infection (anti-HBc+ only) also carries reactivation risk, particularly with Rituximab.
Reference: BAD 2020 Biologic Guidelines; EASL HBV Guidelines