Should All Patients Get Hep B Screening Before Immunosuppressants?

Perrillo RP, Martin P, Lok AS. Preventing Hepatitis B Reactivation Due to Immunosuppressive Drug Treatments. JAMA. 2015; doi:10.1001/jama.2015.2571. Online March 19, 2015.

Should all patients or only high-risk patients be screened for hepatitis B virus (HBV) before receiving immunosuppressive drug therapy?

A survey of 1,000 ACR members found that only 69% performed universal screening prior to prescribing biologic anti-rheumatic agents. Yet the costs of screening are low, and the dangers of HBV reactivation are great, say these hepatologists from three major academic medical centers.

For populations with a low (<2%) prevalence of infection, and immunosuppressants with a low- to

moderate risk of inducing reactivation, targeted screening with HBsAg may suffice, the authors concede. Otherwise, screening for both HBsAg and anti-HBc is appropriate.

The National Psoriasis Foundation recommended in 2014 that all patients who are candidates for tumor necrosis factor (TNF) inhibitors, ustekinumab, cyclosporine, or methotrexate should be screened.

The American College of Rheumatology (ACR) guidelines had no recommendation for screening.