Safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and chronic viral hepatitis B or C: a retrospective, multicentre study in a clinical setting
Por:
Navarro, R, Vilarrasa, E, Herranz, P, Puig, L, Bordas, X, Carrascosa, JM, Taberner, R, Ferran, M, Garcia-Bustinduy, M, Romero-Mate, A, Pedragosa, R, Garcia-Diez, A, Dauden, E
Publicada:
1 mar 2013
Resumen:
Background Both the safety and efficacy of biologic therapy may be affected in the presence of highly prevalent chronic viral hepatitis.
Objectives To evaluate the safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and concomitant chronic viral hepatitis.
Methods This was a retrospective, multicentre study. Twenty-five patients with psoriasis and concurrent hepatitis C virus (HCV) (20 patients) or hepatitis B virus (HBV) (five patients) infection who had received at least one biologic agent (etanercept, 21 treatments; adalimumab, four; ustekinumab, four; infliximab, two) were included. Clinical, imaging and laboratory data were recorded.
Results In the case of HCV infection, the majority of the patients did not exhibit increases in their viral load or serum liver tests. Aspartate aminotransferase, alanine aminotransferase and gamma glutamyl transpeptidase were doubled from the baseline measurement in only one patient treated with etanercept. Two other cases exhibited viral load increases during the follow-up period. In total, 18 of the 26 treatments achieved a 75% improvement in their Psoriasis Area and Severity Index (PASI 75) score during the follow-up period. Two patients treated with etanercept were diagnosed with hepatocellular carcinoma. In the case of HBV infection, all of the patients were being treated with antiviral therapy, and none presented significant variations in viral load or serum liver enzymes. All patients achieved a PASI 75 during follow-up.
Conclusions Biologic therapy was effective and safe for the majority of our patients with HCV and HBV infection, although there may be a risk of reactivation or aggravation. We describe the first cases to receive ustekinumab. The use of biologics should be limited to those cases in which the risk-benefit ratio is justified.
Filiaciones:
Navarro, R:
Hosp Univ Princesa, Dept Dermatol, Madrid, Spain
Vilarrasa, E:
Univ Autonoma Barcelona, Dept Dermatol, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Herranz, P:
Hosp Univ La Paz, Dept Dermatol, Madrid, Spain
Puig, L:
Univ Autonoma Barcelona, Dept Dermatol, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Bordas, X:
Bellvitge Hosp, Dept Dermatol, Barcelona, Spain
Carrascosa, JM:
Hosp Badalona Germans Trias & Pujol, Dept Dermatol, Badalona, Spain
Taberner, R:
Hosp Son Llatzer, Dept Dermatol, Mallorca, Spain
Ferran, M:
Hosp Mar, Dept Dermatol, Barcelona, Spain
Garcia-Bustinduy, M:
Hosp Univ Canarias, Dept Dermatol, San Cristobal la Laguna, Spain
Romero-Mate, A:
Hosp Fuenlabrada, Dept Dermatol, Madrid, Spain
Pedragosa, R:
Hosp Plato, Dept Dermatol, Barcelona, Spain
Garcia-Diez, A:
Hosp Univ Princesa, Dept Dermatol, Madrid, Spain
Dauden, E:
Hosp Univ Princesa, Dept Dermatol, Madrid, Spain
|