title: Are Anti-TNF-α Agents Safe for Treating Psoriasis in Hepatitis C Virus Patients with Advanced Liver Disease? Case Reports and Review of the Literature.
abstract: Tumor necrosis factor-alpha (TNF-α) inhibitors represent an effective treatment for severe psoriasis in hepatitis C virus (HCV) patients. The literature reports mainly on short-term treatment in patients with chronic hepatitis with minimum-to-moderate activity with an acceptable safety profile. We report the first 2 cases of hepatocellular carcinoma (HCC) arising in HCV psoriatic patients with advanced liver disease during long-term treatment with etanercept. Our first patient, known to have had HCV infection for 41 years, developed an HCC after 21 months of therapy with etanercept (50 mg/week). The second patient, HCV+ for 20 years, was treated for 58 months with the same therapy, and despite no signs of liver function impairment was diagnosed with HCC. Both of them presented with cirrhosis, which was diagnosed 9 and 5 years earlier, respectively. It remains to be clarified whether there is any connection between psoriasis treatment with anti-TNF-α agents and the development of HCC in HCV-infected patients. Further long-term, follow-up studies and registries of HCV patients with mild/moderate activity may contribute to clarify this issue.
authors.affiliation: Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Nuzzo
authors.forename: Valeria
authors.initials: V
authors.lastname: Boccaletti
authors.forename: Carolina
authors.initials: C
authors.lastname: Fantini
authors.forename: Chiara
authors.initials: C
authors.lastname: Cortelazzi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fabrizi
authors.forename: Torello
authors.initials: T
authors.lastname: Lotti
authors.forename: Jana
authors.initials: J
authors.lastname: Hercogová
authors.forename: Calogero
authors.initials: C
authors.lastname: Pagliarello
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology; D000068800:Etanercept / Q000009:adverse effects*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept