Safety and efficacy of HCV eradication during etanercept treatment for severe psoriasis

Abstract

Treatment of severe psoriasis in HCV positive patients is challenging, because several psoriasis medications have a toxic effect on the liver, and interferon alpha, used to treat hepatitis, can induce worsening of psoriatic lesions. TNF-alpha inhibitors seem to be a safe and effective option in HCV positive psoriatic patients, but there are concerns about long-term safety, impact on liver fibrosis progression and risk of immune-mediated liver injury. With regard to HCV treatment, new direct-acting antiviral therapies (DAA) seem to be extremely effective, with minimal side effects, but little is known about possible interactions with other medications, particularly with biologics. We report the case of a psoriatic patient, in treatment with Etanercept, who needed to undergo HCV eradication with Daclastavir and Sofosbuvir because of worsening liver fibrosis due to chronic hepatitis C. The present treatment produced excellent results in terms of HCV eradication and control of psoriatic lesions, without side effects.

TNF-Alpha Inhibitors and Ustekinumab for the Treatment of Psoriasis: Therapeutic Utility in the Era of IL-17 and IL-23 Inhibitors

“…41 There are other reports that evaluate the use of etanercept in patients with psoriasis and concomitant HCV infection, which also demonstrate a favorable safety profile. 42-51…”

Severe Psoriasis Successfully Treated with Brodalumab after Eradication of Hepatitis C Virus with Glecaprevir and Pibrentasvir: A Case Report

“…However, patients should be examined for HCV infection before biologic therapy and, if administration is necessary in HCV-positive patients, they should be carefully followed-up 1 . Regarding HCV treatment, new direct-acting antiviral agents (DAAs) are extremely effective and the rate of sustained viral response (SVR) is very high 2 3 . Here we report the first case of severe psoriasis successfully treated with brodalumab after the eradication of HCV with glecaprevir and pibrentasvir.…”

“…A systematic review of the literature disclosed that viral reactivation occurred in 3/97 patients with HCV infection (yearly rate 2.42%) 5 . Pescitelli et al 2 reported a case with successful HCV eradication by the new DAAs daclastavir and sofosbuvir during the treatment of severe psoriasis with the tumor necrosis factor-α inhibitor etanercept. Now that highly effective new DAAs are available for chronic HCV, it is desirable to consult hepatologists and eradicate HCV before the initiation of biologic therapy for severe psoriasis.…”