BI44 Hepatitis B reactivation risk perception and viral screening practices among Irish dermatologists

Abstract

Hepatitis B virus (HBV) reactivation is a recognized complication of immunosuppressive and immunomodulatory therapies, with potential for significant morbidity. The use of biologic agents and targeted therapies in dermatology has expanded rapidly, yet uncertainty remains regarding HBV reactivation risk across specific drug classes. Real-world data on dermatology clinicians’ screening practices and risk perception are limited. This survey explored viral prescreening practices and perceived HBV reactivation risks of specific immunomodulatory drug classes among dermatology clinicians in Ireland. An anonymous online questionnaire was distributed to members of the Irish Association of Dermatologists. Of 39 respondents, 53% were consultants, 24% specialist registrars and 21% registrars. Prescreening typically included hepatitis B core antibody and surface antigen testing (both 95%), hepatitis C antibody (92%) and HIV (95%). Varicella zoster titres were included by 33%. In 49% of centres, both hepatitis B core antibody and surface antigen testing serology were automatically included; 44% required individual ordering. All respondents (100%) completed prescreening for B-cell-depleting agents, tumour necrosis factor (TNF)-α inhibitors and ‘other’ cytokine inhibitors [interleukin (IL)-17/IL-23]. Only 10% of prescreened patients on high-dose steroids (prednisolone > 20 mg for > 4 weeks). Screening was performed by 26% for IgE inhibitors and 69% for IL-4/IL-13 inhibitors. Therapies perceived as low risk included low-dose steroids (prednisolone < 20 mg daily for < 4 weeks) (82%), IL-4/IL-13 inhibitors (82%), other cytokine inhibitors (IL-17/IL-23) (51%) and IgE inhibitors (87%). Moderate risk was associated with disease-modifying antirheumatic drug (DMARD) monotherapy (54%), immunophilin inhibitors (49%) and TNF-α inhibitors (56%). High risk was most often attributed to B-cell-depleting therapies (72%) and combination therapy with high-dose steroids and DMARDs (47%). Risk ratings varied for Janus kinase and tyrosine kinase inhibitors: 39% judged them moderate and 33% high. Viral prescreening is widely adopted, although approaches vary. Perceived risk of hepatitis B reactivation differs across drug classes; however, high-dose steroids were infrequently understood as high risk. This understanding could be practice changing for dermatologists.