Therapy
Etanercept therapy for patients with psoriatic arthritis and concurrent hepatitis C virus infection: Report of 3 cases

https://doi.org/10.1016/j.jaad.2004.05.013Get rights and content

Psoriasis and psoriatic arthritis are exacerbated by interferon alfa and other treatments for hepatitis C virus infection. Immunosuppressants and hepatotoxic drugs are relatively contraindicated in hepatitis C. Data in the literature suggest that etanercept is a safe option in the treatment of patients with rheumatoid arthritis and concurrent hepatitis C. We present three cases in which we have successfully used etanercept to treat psoriatic arthritis/psoriasis in patients with hepatitis C without worsening their hepatitis or interfering with their hepatitis treatment. With close monitoring of viral load and hepatic enzymes, etanercept may be a safe option for treating psoriatic arthritis/psoriasis in patients who also have hepatitis C.

Section snippets

Case 1

A 51-year-old white man with a 15-year history of severe psoriasis vulgaris and an 8-year history of PsA had been given the diagnosis of chronic hepatitis C infection 4 years ago. A liver biopsy specimen in August 2000 revealed chronic hepatitis morphologically consistent with known hepatitis C infection, with minimal to mild activity (grade 2) and portal fibrosis. In March 2003, he began treatment with pegylated interferon alfa-2a once weekly combined with ribavirin, which exacerbated his PsA

Discussion

Based on our findings in these 3 patients with PsA, we conclude that etanercept demonstrated efficacy and may be used safely for patients with psoriasis/PsA and concurrent HCV infection. It reduces dependence on corticosteroids and does not appear to significantly affect hepatic function tests or viral load during short-term use. As with any new drug, a note of caution should be added in that we do not yet know how etanercept affects active infection with HCV. We recommend consultation with a

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    Dr Magliocco is the recipient of an unrestricted, educational Amgen-funded grant.

    Disclosures: Drs Magliocco and Gottlieb are investigators in Amgen and Centocor clinical trials. Dr Magliocco is the recipient of an unrestricted, educational Amgen-funded grant and fellowship in clinical immunology. Dr Gottlieb is a consultant and speaker for Amgen/Wyeth. She is also a consultant for Centocor.

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    Copyright © 2004 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.