Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection: a multicentre cohort study of 37 patients and review of the literature.
BACKGROUND
Little data are available about the safety of TNF-α inhibitors in patients with HCV and HBV infection. In particular, data concerning the use of adalimumab in patients with psoriasis and concomitant viral hepatitis are lacking and little is known about the drug's real safety in this context.


OBJECTIVE
To assess the long-term safety of adalimumab in a group of 17 consecutive psoriatic patients affected by chronic HBV infection and 20 consecutive psoriatic patients affected by chronic HCV infection.


METHODS
Thirty-seven consecutive patients with psoriasis and concomitant HBV or HCV infection being treated with adalimumab at four Italian referral centres (Modena, Padova, Verona and Turin) were assessed before the treatment and at the end of follow-up. Viral load and radiological studies (echography, Fibroscan) were also carried out in some of the patients.


RESULTS
The patients responded well to treatment and did not show any HBV or HCV reactivation in a mean follow-up period of 27 and 40 months, respectively. The fibrosis score in eight HCV patients showed a slight reduction: pretreatment mean value 5.83 and post-treatment mean value 5.65.


CONCLUSIONS
The use of adalimumab seems to be safe in patients with severe psoriasis and HBV or HCV infection. Nevertheless, large-scale prospective studies will be able to provide vital information on the impact of anti-TNF treatment on hepatic function in patients with psoriasis and concomitant chronic HCV or HBV infection and appropriate monitoring scheduling.
Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
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Piaserico
Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.
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Dapavo
Dermatology Unit, Department of Medicine and Medical Specialties, University of Modena, Modena, Italy.
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Conti
Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
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Gisondi
Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
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Russo
D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007558:Italy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D019562:Viral Load; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000068879:Adalimumab