{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:41:27Z","timestamp":1747186887382,"version":"3.40.5"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004853","name":"Chinese University of Hong Kong","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004853","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is uncertain whether biological therapies would increase the risk of hepatitis among patients with past hepatitis B virus (HBV) infection. This study aimed to evaluate the risk of alanine aminotransferase (ALT) flare in patients with past HBV infection while using biological therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>Patients who received biological therapies for \u22653\u00a0months from 2000 to 2019 were identified from a population\u2010based database in Hong Kong. Patients with past HBV infection were compared with a control group without prior HBV exposure. The primary endpoint was development of ALT flare within 5\u2009years of starting biological therapies, defined as ALT\u2009&gt;80\u2009IU\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 2471 and 2394 patients with and without past HBV infection respectively. There was a non\u2010significant increase in risk of ALT flare among the HBV\u2010exposed group (27.6% vs. 23.7%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.055). In multivariable analysis, using prednisolone\u2010equivalent dose of &gt;20\u2009mg daily, male sex and concomitant immunosuppressants were risk factors for ALT flare. The risk of ALT flare was significantly higher with anti\u2010CD20 when compared to other biological agents (36.1% vs. 14.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01), but was not significantly different among anti\u2010tumour necrosis factor, anti\u2010cytokine, Janus kinase inhibitors and T cell\/B cell inhibitors or anti\u2010integrin (15.2% vs. 14.6% vs. 11.7% vs. 11.1%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.82). Among patients with documented hepatitis B surface antigen seroreversion, 96% were on anti\u2010CD20.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study further supports the current suggestion of prophylactic anti\u2010viral before starting anti\u2010CD20 in HBV\u2010exposed patients. While other biological therapies appear to have a lower risk for ALT flare, this result needs further confirmation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15499","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T20:45:52Z","timestamp":1671050752000},"page":"588-598","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk of alanine aminotransferase flare in patients with previous hepatitis B virus exposure on biological modifier therapies\u2014A population\u2010based study"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7706-6209","authenticated-orcid":false,"given":"Jacky C. L.","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce W. 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