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Li L, Jiang X, Fu L, Zhang L, Feng Y. Reactivation rates of hepatitis B or C or HIV in patients with psoriasis using biological therapies: a systematic review and meta-analysis. Clin Exp Med 2022:10.1007/s10238-022-00827-y. [PMID: 35499793 DOI: 10.1007/s10238-022-00827-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023]
Abstract
Some biological therapies for psoriasis can cause the reactivation of viral infections. Although recent studies suggest no increased rate of reactivation with biological therapies, some life-threatening cases have been reported. Therefore, this meta-analysis examined the rate of virus reactivation in patients with psoriasis with biological therapies and concurrent hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection. PubMed, Embase, and the Cochrane Library were searched for available papers from inception to December 2021. The outcome was the number of patients with virus reactivation after using biological therapies. The random-effect model was used in all analyses. Fourteen reports (1033 patients) were included. The pooled overall rate of virus reactivation was 0.04 (95%CI 0.01-0.09; I2 = 67.7%, P < 0.001). The pooled rates of HBV, HCV, and HIV reactivation were 0.04 (95%CI 0.00-0.10; I2 = 79.9%, P < 0.001), 0.07 (95%CI 0.02-0.14; I2 = 23.7%, P = 0.24), and 0.12 (95%CI 0.00-0.40), respectively. The pooled rates of HBV and HCV reactivation were 0.10 (95%CI 0.03-0.19) and 0.08 (95%CI 0.03-0.15) in Asia, but 0.00 (95%CI 0.00-0.01) and 0.04 (95%CI 0.00-0.21) in Europe. The publication type also influenced the results. The use of biological therapy in patients with psoriasis and HBV, HCV, or HIV infection might be associated with the rate of viral reactivation, but this meta-analysis had limitations, and the evidence might be weak. Nevertheless, it might suggest that at least a consultation with an infection specialist might be warranted in patients with psoriasis in whom biological therapies are considered.
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Affiliation(s)
- Lin Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Lixin Fu
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Liwen Zhang
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Yanyan Feng
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
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Hagberg KW, Persson R, Vasilakis-Scaramozza C, Niemcryk S, Peng M, Paris M, Lindholm A, Jick S. Herpes Zoster, Hepatitis C, and Tuberculosis Risk with Apremilast Compared to Biologics, DMARDs and Corticosteroids to Treat Psoriasis and Psoriatic Arthritis. Clin Epidemiol 2020; 12:153-161. [PMID: 32104099 PMCID: PMC7024766 DOI: 10.2147/clep.s239511] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/24/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose Psoriasis and psoriatic arthritis (PsA) are associated with an increased infection risk. In this cohort study of patients with treated psoriasis or PsA, we used MarketScan (2014–2018) to estimate rates of herpes zoster, hepatitis C (HepC) and tuberculosis (TB) with apremilast compared to other systemic treatments. Materials and Methods Patients were exposed from first apremilast [APR], DMARD, TNF-inhibitor [TNF], IL-inhibitor [IL], or corticosteroids [CS] prescription after March 21, 2014. Study exposures were APR, DMARDs only, TNF-only, IL-only, CS-only, DMARDs+CS, TNF+DMARDs and/or CS, IL+DMARDs and/or CS. Cases had treated herpes zoster, HepC, or TB event. We calculated incidence rates (IRs) [95% confidence intervals] per 1000 patient-years. Results The study population included 131,604 patients. For herpes zoster (N=2271), IRs were highest for users of DMARDs+CS (12.5 [9.8–15.7]), CS-only (12.5 [10.4–14.1]), and TNF+DMARDs and/or CS (11.9 [10.6–13.4]), compared with DMARDs only (9.9 [8.7–11.2]). IRs were lowest for users of IL-only (6.7 [5.8–7.8]) and APR (7.0 [5.8–8.4]). IRs of HepC (N=150) and TB (N=81) were low and between-treatment differences were not significant. Conclusion Rates of herpes zoster varied by treatment: highest among those who received polytherapy, lowest in users of apremilast only. IRs for HepC and TB were low for all exposures.
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Affiliation(s)
| | - Rebecca Persson
- Boston Collaborative Drug Surveillance Program, Lexington, MA 02421, USA
| | | | | | | | | | | | - Susan Jick
- Boston Collaborative Drug Surveillance Program, Lexington, MA 02421, USA.,Boston University School of Public Health, Lexington, MA 02421, USA
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Siegel S, Winthrop K, Ehst B, Ortega Loayza A. Ustekinumab use in patients with severe psoriasis co‐infected with hepatitis B and/or C. Br J Dermatol 2019; 180:1232-1233. [DOI: 10.1111/bjd.17444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S.A.R. Siegel
- School of Public Health Oregon Health & Science University Portland OR U.S.A
| | - K.L. Winthrop
- School of Public Health Oregon Health & Science University Portland OR U.S.A
- Division of Infectious Diseases Oregon Health & Science University Portland OR U.S.A
| | - B.D. Ehst
- Oregon Medical Research Portland OR U.S.A
| | - A. Ortega Loayza
- Department of Dermatology Oregon Health & Science University Portland OR U.S.A
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Velázquez Tarjuelo D, de la Cueva Dobao P. Certolizumab in a patient with severe psoriasis and concomitant hepatitis C virus infection. JAAD Case Rep 2018; 4:833-834. [PMID: 30238050 PMCID: PMC6143696 DOI: 10.1016/j.jdcr.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lopetuso LR, Mocci G, Marzo M, D'Aversa F, Rapaccini GL, Guidi L, Armuzzi A, Gasbarrini A, Papa A. Harmful Effects and Potential Benefits of Anti-Tumor Necrosis Factor (TNF)-α on the Liver. Int J Mol Sci 2018; 19:E2199. [PMID: 30060508 PMCID: PMC6121684 DOI: 10.3390/ijms19082199] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023] Open
Abstract
Anti-tumor necrosis factor (TNF)-α agents represent an effective treatment for chronic inflammatory diseases. However, some concerns about their potentially undesirable effects on liver function have been reported. On the other hand, evidence of their therapeutic effects on certain liver diseases is accumulating. Many data showed the safety of anti-TNF-α in patients with chronic hepatitis B and C and in liver transplanted patients even if a strict follow-up and prophylaxis are recommended in well-defined subgroups. On the other side, anti-TNF-α-induced liver injury is not a rare event. However, it is often reversible after anti-TNF-α withdrawal. Anti-TNF-α agents have been tested in advanced stages of severe alcoholic hepatitis and non-alcoholic fatty liver disease. Limited data on the efficacy of anti-TNF-α in patients with autoimmune hepatitis and primary biliary cholangitis are also available. In this review, we explored the hepatic safety concerns in patients receiving anti-TNF-α agents with and without pre-existent hepatic diseases. In addition, the available evidence on their potential benefits in the treatment of specific hepatic diseases is discussed.
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Affiliation(s)
- Loris Riccardo Lopetuso
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Giammarco Mocci
- Gastroenterology Unit, Brotzu Hospital, 09121 Cagliari, Italy.
| | - Manuela Marzo
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Francesca D'Aversa
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Gian Lodovico Rapaccini
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Luisa Guidi
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Alessandro Armuzzi
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Alfredo Papa
- Internal Medicine and Gastroenterology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
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Damiani G, Franchi C, Pigatto P, Altomare A, Pacifico A, Petrou S, Leone S, Pace MC, Fiore M. Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents. World J Hepatol 2018; 10:329-336. [PMID: 29527268 PMCID: PMC5838451 DOI: 10.4254/wjh.v10.i2.329] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/18/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C (CHC) treated with new Direct-Acting Antiviral agents (DAAs) compared to pegylated interferon-2α plus ribavirin (P/R) therapy.
METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus (HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index (PASI) scores and the Dermatology Quality of Life Index (DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different bDMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response (SVR) were considered as outcomes of HCV therapy.
RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower (P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group (0/27) compared to 8 patients of the P/R group (8/32) needed a shift in biological treatment.
CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.
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Affiliation(s)
- Giovanni Damiani
- Study Center of Young Dermatologists Italian Network (YDIN), Gised, Bergamo, Italy and Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Chiara Franchi
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Paolo Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Andrea Altomare
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Alessia Pacifico
- San Gallicano Dermatological Institute, IRCCS, Rome 00144, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, St. George’s University Medical School, Grenada, West Indies
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
| | - Maria Caterina Pace
- Department of Anesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Marco Fiore
- Department of Anesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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AlMutairi N, Abouzaid HA. Safety of biologic agents for psoriasis in patients with viral hepatitis. J DERMATOL TREAT 2018; 29:553-556. [PMID: 29345515 DOI: 10.1080/09546634.2018.1430301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Biologics are highly effective, important treatment options for moderate-to-severe psoriasis. Biologics are well tolerated and have few side effects. However, the use of biologics in patients with concomitant chronic viral hepatitis is debatable. Recent reports have suggested a very low associated risk of reactivation of chronic hepatitis B (HBV) and C (HCB). OBJECTIVE To evaluate the safety and effectiveness of biologics for moderate to severe psoriasis patients with concomitant chronic viral hepatitis. METHODS We followed 39 patients with psoriasis and concurrent chronic viral hepatitis (chronic inactive and occult cases) with no clinical signs and/or lab indication of active liver disease) treated with biologic agents for at least 24 weeks. Patients were regularly monitored for reactivation of viral hepatitis with liver enzymes, viral DNA load, and viral markers. RESULTS There was no evidence of viral reactivation until the last available lab investigation results (done three months after stopping the medication). None of the patients showed signs or symptoms of liver failure. CONCLUSION The use of biologic therapy appeared safe and effective in this small cohort of selected patients with chronic HBV and HCV infection. Close monitoring for HBV and HCV viral load is recommended for patients with high-risk factors.
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Affiliation(s)
- Nawaf AlMutairi
- a Department of Medicine, Faculty of Medicine , Kuwait University , Farwaniya , Kuwait
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Lindhaus C, Tittelbach J, Elsner P. Cutaneous side effects of TNF-alpha inhibitors. J Dtsch Dermatol Ges 2017; 15:281-288. [PMID: 28252861 DOI: 10.1111/ddg.13200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/03/2016] [Indexed: 12/14/2022]
Abstract
Since the early 1990s, tumor necrosis factor alpha (TNF-alpha) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. By now, comprehensive safety data has been compiled. While adverse reactions do occur, they are - in relation to the frequent use of these agents - rare and usually not serious. Cutaneous side effects include local injection site reactions, infections, immune-mediated reactions, and neoplasms. The most common serious adverse events are of an infectious nature. Mycobacteria but also non-mycobacterial pathogens, such as viruses and fungi, may cause serious, even lethal, systemic infections. The present article is meant to review current knowledge with respect to cutaneous side effects of TNF-alpha inhibitors.
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Affiliation(s)
- Claudia Lindhaus
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Jörg Tittelbach
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
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Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies: A retrospective cohort study and systematic review of the literature. J Am Acad Dermatol 2017; 77:88-97.e5. [DOI: 10.1016/j.jaad.2017.01.037] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 12/25/2022]
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Martinez-Santana V, Rodriguez-Murphy E, Smithson A, Miserachs-Aranda N, Del Río-Gil R, Torre-Lloverás I. Efficacy and safety of direct-acting antiviral agents when combined with secukinumab. Eur J Hosp Pharm 2017; 25:53-56. [PMID: 31156986 DOI: 10.1136/ejhpharm-2017-001212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/23/2023] Open
Abstract
Background The interference in the immune response induced by biological disease-modifying antirheumatic drugs (bDMARDs) increases the risk of reactivation of infections. Treatment of patients with chronic hepatitis C virus (HCV) infection and psoriasis is complex. The efficacy and safety of the new direct-acting antiviral agents (DAA) when combined with bDMARDs remain unknown. Case report We present a case of a 44-year-old Caucasian man affected with psoriasis and HCV infection. Throughout the course of the psoriatic disease, this patient received several lines of treatment, including secukinumab, a new type of bDMARD. At the time of commencing secukinumab, new DAA agents (ledipasvir/sofosbuvir) were also initiated. At week 12 post-treatment, hepatitis C viral load was undetectable and the patient remained in remission of psoriasis. Conclusion This case report suggests that secukinumab is a therapeutic option in patients with psoriasis, particularly in those cases with HCV infection where treatment with DAA agents is warranted.
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Affiliation(s)
| | | | - Alex Smithson
- Infectious Diseases Unit, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - Nuria Miserachs-Aranda
- Pharmacy, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - Ruben Del Río-Gil
- Dermatology, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
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Lindhaus C, Tittelbach J, Elsner P. Nebenwirkungen von TNF-alpha-Inhibitoren am Hautorgan. J Dtsch Dermatol Ges 2017; 15:281-288. [DOI: 10.1111/ddg.13200_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia Lindhaus
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Jena Deutschland
| | - Jörg Tittelbach
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Jena Deutschland
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena; Jena Deutschland
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Bonifati C, Lora V, Graceffa D, Nosotti L. Management of psoriasis patients with hepatitis B or hepatitis C virus infection. World J Gastroenterol 2016; 22:6444-6455. [PMID: 27605880 PMCID: PMC5006156 DOI: 10.3748/wjg.v22.i28.6444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV). In particular, the patients eligible to receive an immunosuppressive drug must be screened for the following markers: antibody to hepatitis B core, antibody to hepatitis B surface antigen (anti-HBsAg), HBsAg, and antibody to HCV (anti-HCV). In case HBV or HCV infection is diagnosed, a close collaboration with a consultant hepatologist is needed before and during an immunosuppressive therapy. Concerning therapy with immunosuppressive drugs in PsO patients with HBV or HCV infection, data exist mainly for cyclosporine a (CyA) or bDMARDs (etanercept, adalimumab, infliximab, ustekinumab). The natural history of HBV and HCV infection differs significantly as well as the effect of immunosuppression on the aforementioned infectious diseases. As a rule, in the case of active HBV infection, systemic immunosuppressive antipsoriatic therapies must be deferred until the infection is controlled with an adequate antiviral treatment. Inactive carriers need to receive antiviral prophylaxis 2-4 wk before starting immunosuppressive therapy, to be continued after 6-12 mo from its suspension. Due to the risk of HBV reactivation, these patients should be monitored monthly for the first 3 mo and then every 3 mo for HBV DNA load together with transaminases levels. Concerning the patients who are occult HBV carriers, the risk of HBV reactivation is very low. Therefore, these patients generally do not need antiviral prophylaxis and the sera HBsAg and transaminases dosing can be monitored every 3 mo. Concerning PsO patients with chronic HCV infection their management with immunosuppressive drugs is less problematic as compared to those infected by HBV. In fact, HCV reactivation is an extremely rare event after administration of drugs such as CyA or tumor necrosis factor-α inhibitors. As a rule, these patients can be monitored measuring HCV RNA load, and ALT, aspartate transaminase, gamma-glutamyl-transferase, bilirubin, alkaline phosphatase, albumin and platelet every 3-6 mo. The present article provides an updated overview based on more recently reported data on monitoring and managing PsO patients who need systemic antipsoriatic treatment and have HBV or HCV infection as comorbidity.
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