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

P>Introduction Tumour necrosis factor (TNF)-alpha antagonists are effective for the treatment of plaque-type psoriasis and psoriatic arthritis, but concerns remain about the safety of these agents in the presence of chronic infections, including past hepatitis B (HBV) and chronic hepatitis C virus (HCV) infections. Objective To assess the safety of TNF-alpha therapy in patients with plaque-type psoriasis and concurrent past HBV or chronic HCV. Methods Data were collected retrospectively from patients in the PsoCare Centre, Division of Dermatology II, Florence University. Patients with plaque-type psoriasis who were receiving anti-TNF-alpha therapy were retrospectively reviewed for the presence of HBV or HCV by a serological evaluation. Results Seventeen patients (13 men and four women, age 36-74 years) with plaque-type psoriasis associated with hepatitis infections (11 with past HBV infection, five with chronic HCV infection and one affected by both HBV and HCV) were identified. Fourteen patients had received etanercept, two adalimumab and one adalimumab as a second biologic treatment after an unsuccessful trial of etanercept. In none of the cases were changes in serum aminotransferases or viral load reported. Conclusions In our analysis, the use of anti-TNF-alpha 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-alpha antagonists in these patients.