Psoriasis treated with ustekinumab in a patient with hepatitis C

Abstract

References1 Amano M, Grant A, Kerdel FA. A prospective open-label clinical trial of adalimumab for the treatment of hidradenitis suppurativa. Int J Dermatol 2010; 49: 950-955. 2 Moul DK, Korman NJ. Severe hidradenitis suppurativa treated with adalimumab. Arch Dermatol 2006; 142: 1110-1112. 3 Scheinfeld N. Treatment of coincident seronegative arthritis and hidradenitis suppurativa with adalimumab. J Am Acad Dermatol 2006; 55: 163-164. 4 Yamauchi P, Mau N. Hidradenitis suppurativa managed with adalimumab. J Drugs Dermatol 2009; 8: 181-183. 5 Blanco R, Martinez-Taboada VM, Villa I, et al. Longterm successful adalimumab therapy in severe hidradenitis suppurativa. Arch Dermatol 2009; 145: 580-584. 6 van der Zee HH, Boer J, Prens EP, Jemec GB. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatology 2009; 219: 143-147. 7 Sartorius K, Lapins J, Jalal S, et al. Bacteremia in patients with hidradenitis suppurativa undergoing carbon dioxide laser surgery: detection and quantification of bacteria by lysis-filtration. Dermatology 2006; 213: 305-312. 8 Russ E, Castillo M. Lumbosacral epidural abscess due to hidradenitis suppurativa. AJR Am J Roentgenol 2002; 178: 770-771. 9 Dixon WG, Watson K, Lunt M, et al. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving antitumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register.

The safety profile of ustekinumab in the treatment of patients with psoriasis and concurrent hepatitis B or C

“…25 Biological agents for the treatment of psoriasis and psoriatic arthritis show selective immunosuppressive effects with no direct hepatic or renal toxicity. 10,11,29,30 IL-12 is important in achieving sustained control of HBV replication. The use of TNF-a therapy in patients with psoriasis and HBV is considered to be safe under routine or pre-emptive antiviral use.…”

“…[42][43][44] Serum level and hepatic expression of IL-23 were significantly upregulated in patients with chronic hepatitis B and were positively correlated with the histological activity index score, HBV DNA load, and serum AST and ALT levels. 10,11,29,30 One case report described HBV reactivation during therapy with ustekinumab for psoriasis in an HBsAgnegative and anti-HBs-positive patient. 45 Based on these results, the theoretical risk of viral hepatitis reactivation exists following treatment with an IL-12/IL-23 inhibitor, such as ustekinumab.…”

“…Nevertheless, there is limited experience on the use of ustekinumab, an anti-IL12/IL-23 agent, in patients with HBV or HCV infection. 10,11,29,30 IL-12 is important in achieving sustained control of HBV replication. 31,32 IL-12 can promote cell-mediated immunity by facilitating type 1 T helper (Th1) lymphocyte responses and inhibit HBV replication by stimulating interferon-c production.…”

“…Nevertheless, only three case reports and a small case series have investigated the safety of ustekinumab in the setting of chronic viral infections. 10,11,29,30 One case report described HBV reactivation during therapy with ustekinumab for psoriasis in an HBsAgnegative and anti-HBs-positive patient. 10 Opel et al reported that two HBsAg-negative patients with psoriasis, who acquired acute HBV infection, generated an abnormal immune response towards HBV and experienced typical courses of infection without progression to chronic HBV infection on ustekinumab treatment during a phase 3 (PHOENIX 1) and a phase 4 (TRANSIT) study, respectively.…”

Hepatic complications induced by immunosuppressants and biologics in inflammatory bowel disease

“…In another retrospective study, 3 patients with HCV and 1 patient with HBV under prophylaxis with entecavir were treated with ustekinumab and didn’t have an aggravation of the hepatitis[153]. Cases of acute HBV infection/HBV reactivation during ustekinumab treatment and, on the other hand, cases where ustekinumab was safely administered despite HBV or HCV infection were reported recently[154-157]. Even though a real frequency of hepatic adverse events is not yet known for these drugs, this evidence suggests that all patients considered for biologic treatment should be screened for hepatitis B and C infection prior to introduction of the drug, and liver function should be monitored periodically for the duration of the treatment.…”