Chronic hepatitis C virus hepatitis and psoriasis: No longer a contraindication to interferon use in the era of biological agents?

Bartalesi, Filippo; Salomoni, E; Cavallo, Annalisa; Corti, Giampaolo; Pimpinelli, Nicola; Bartoloni, Alessandro; Taliani, Gloria

doi:10.3109/00365548.2012.720026

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…104 A patient with psoriasis treated with etanercept concomitantly with pegIFN-α2a and RBV achieved SVR and improvement in the symptoms of psoriasis, but glossopharyngeal neuralgia recurred and required surgical nerve excision. 103 Taken together, the results of these studies show that IFN-based treatments can be given to patients on TNF-α inhibitors, but flares of underlying autoimmune diseases can occur. Moreover, one study has an outsized influence on the results due to the absence of other studies with large numbers of patients.…”

Section: Resultsmentioning

confidence: 86%

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

Ooka

Lim

2016

JCTH

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With 185 million people chronically infected globally, hepatitis C is a leading bloodborne infection. All-oral regimens of direct acting agents have superior efficacy compared to the historical interferon-based regimens and are significantly more tolerable. However, trials of both types of regimens have often excluded patients on immunosuppressive medications for reasons other than organ transplantation. Yet, these patients—most often suffering from malignancy or autoimmune diseases—could stand to benefit from these treatments. In this study, we systematically review the literature on the treatment of hepatitis C in these neglected populations. Research on patients with organ transplants is more robust and this literature is reviewed here non-systematically. Our systematic review produced 2273 unique works, of which 56 met our inclusion criteria and were used in our review. The quality of data was low; only 3 of the 56 studies were randomized controlled trials. Sustained virologic response was reported sporadically. Interferon-containing regimens achieved this end-point at rates comparable to that in immunocompetent individuals. Severe adverse effects and death were rare. Data on all-oral regimens were sparse, but in the most robust study, rates of sustained virologic response were again comparable to immunocompetent individuals (40/41). Efficacy and safety of interferon-containing regimens and all-oral regimens were similar to rates in immunocompetent individuals; however, there were few interventional trials. The large number of case reports and case series makes conclusions vulnerable to publication bias. While firm conclusions are challenging, given the dearth of high-quality studies, our results demonstrate that antiviral therapy can be safe and effective. The advent of all-oral regimens offers patients and clinicians greatly increased chances of cure and fewer side effects. Preliminary data reveal that these regimens may confer such benefits in immunosuppressed individuals as well. More prospective interventional trials would greatly benefit the many patients with chronic hepatitis C on immunosuppressive therapies.

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Section: Resultsmentioning

confidence: 86%

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

Ooka

Lim

2016

JCTH

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“…Retrospectively our patient had mild psoriatic lesions already at the initial diagnosis of HCV infection. Since they seemed well controlled without specific treatment at the time HCV treatment with peg-INF-α was not contraindicated [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A case of erythrodermia from exacerbated psoriasis vulgaris due to treatment of acute hepatitis C

et al. 2016

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BackgroundSkin side effects during interferon-alpha and ribavirin treatment are common, but autoimmune dermatosis triggered by interferon-alpha is rare. We describe a case of erythrodermia from exacerbated psoriasis during the treatment of acute hepatitis C with pegylated-interferon-alpha and ribavirin. The incidence of psoriasis in this circumstance is unknown and only 36 cases are described in the literature, of which only one describes an erythrodermic psoriasis flare.Case presentationA 50-years old healthy white man presented with the complaints of headache, muscle pain, appetite loss, yellow skin complexion and fatigue. The laboratory results showed elevated liver enzymes above 50 times the upper limit of normal and a positive antibody test and RNA for hepatitis C. A screening test 6 months earlier was negative and therefore the diagnosis of an acute hepatitis C infection was most likely. In the absence of spontaneous clearance of the virus a therapy with pegylated- interferon-α and ribavirin was initiated. After 3 weeks the patient developed red scaly papular skin lesions that evolved despite treatment with prednisone to a severe erythrodermia. A skin biopsy showed typical signs for psoriasis vulgaris. Treatment with steroids was intensified and the hepatitis C therapy stopped. The patient achieved sustained virological response for hepatitis C, but psoriatic lesions were still present 6 months after treatment.ConclusionAlthough autoimmune skin reactions under pegylated-interferon-α and ribavirin treatment are rare it is important to recognise them early to start an adequate treatment to guarantee hepatitis C treatment continuation.

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Peginterferon alfa related psoriasis in a patient with acute hepatitis C and review of the literature

Dağ

Öztürk

Yılmaz

et al. 2013

Wien Klin Wochenschr

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The Interferon (IFN) which is the standard treatment for Hepatitis C, may cause a lot of side effects including dermatological anomalies. This paper presents a psoriasis case which occurred in relation with the treatment of acute hepatitis C (AHC) with peginterferon alfa (peg-IFN-α). A 60-year-old male patient came to the hospital with symptoms of high liver enzymes. The patient with history of a recent operation showed anti-HCV(+), HCVRNA 3.5 million IU/mL and HCV genotype 1b in the tests. Without any other etiological factors found in the patient, we started a treatment of peg-IFNα-2b with the diagnosis of AHC. After 3 weeks, psoriatic plaques were observed in various parts of the body. Antiviral treatment of the patient was concluded within 6 months. His psoriasis treatment initially commenced with local agents followed by phototherapy. Permanent viral response was seen in the patient and his lesions recovered rapidly after the antipsoriatic and antiviral treatment. Psoriasis and other autoimmune diseases should be considered even though they are encountered rarely,and the patients should be informed of the possible risks before planning treatment with peg-IFN-α.

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Chronic hepatitis C virus hepatitis and psoriasis: No longer a contraindication to interferon use in the era of biological agents?

Cited by 7 publications

References 17 publications

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

A case of erythrodermia from exacerbated psoriasis vulgaris due to treatment of acute hepatitis C

Peginterferon alfa related psoriasis in a patient with acute hepatitis C and review of the literature

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