Tumour necrosis factor-α antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C: a retrospective analysis of 17 patients

Abstract

In our analysis, the use of anti-TNF-α therapy appears to be safe as it did not affect serum aminotransferases or viral load. However, repeated monitoring is necessary throughout the treatment period. Systematic, large-scale studies are also needed to assess the risks and benefits of TNF-α antagonists in these patients.

Risk of Reactivation of Hepatitis B Virus Infection in Psoriasis Patients Treated With Biologics: A Retrospective Analysis of 20 Cases From the BIOBADADERM Database

“…We have only found 4 studies of patients with psoriasis treated with anti-TNF agents and past hepatitis B (Table 2). 17,19,24,25 As in our series of cases, no hepatitis reactivation was observed with the use of anti-TNF agents.…”

To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis

“…Among these, 16 studied screening tests in patients without comorbidities 3,12-26 and 13 studied monitoring tests in patients with hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, and congestive heart failure (CHF). 3,17,19,[27][28][29][30][31][32][33][34][35][36] Screening and monitoring tests AntieTNF-a agents were studied in HBV and HCV, tuberculosis, and human immunodeficiency virus (HIV) screening, skin cancer screening, renal, hepatocellular, and biliary liver function, complete blood cell counts (CBCs), urine studies, pregnancy tests, antinuclear antibody (ANA) and doublestranded DNA (dsDNA), and C-reactive protein (CRP). Ustekinumab was studied with regard to tuberculosis and skin cancer screening (Table II).…”

“…31 Among occult HBV carriers, 17 patients received etanercept without antiviral treatment, and no signs of reactivation or changes in AST, ALT, or viral load were seen through an average treatment of 7.8 months. 30 Based on limited evidence from small study populations, the evidence for monitoring liver function and HBV viral loads in patients with HBV is grade C. Current guidelines suggest performing a hepatitis panel before treatment with biologics and treating according to serologic status. In na€ ıve patients at risk for HBV, vaccination should be considered.…”

“…HCV RNA levels were undetectable in all patients throughout a mean treatment of 11 months. 30 However, these anecdotal reports and small-scale studies are insufficient to support or refute the utility of monitoring LFTs and HCV viral load during biologic therapy. In 2 patients with HCV and PsA, the safety of etanercept was evaluated based on liver biopsy specimens obtained at baseline and 12 months of treatment.…”

Safety and Efficacy of Etanercept in a HCV/HBV Patient Affected by Psoriasis

“…However, only one other subject with concomitant active HCV and signs of previous HBV contact has been described so far [6].This report aims to underline the safety of etanercept administration to patients with psoriasis, concomitant HCV infection, mild liver disease, and signs of previous contact with HBV. The anti-TNF drug etanercept was evaluated as an adjuvant to the standard of care IFN and Ribavrin (Rbv) regimen in HCV patients, showing a higher decline of viral load and ALT in the etanercept patients in comparison to the placebo group [7] Monitoring for liver function tests, and hepatitis reactivation/flares remains mandatory since HBV reactivations causing severe episodes of acute hepatitis have been associated to the use of biological therapy.…”