Management of psoriasis patients with hepatitis B or hepatitis C virus infection

Table 1 Therapies approved by European Medicines Agency for the treatment of psoriasis

	Recommended doses for adult patients
Conventional DMARDs
Acitretine	0.25-1 mg/kg per day
Cyclosporin a	2-5 mg/kg per day
Methotrxate	10 mg to 25 mg per week
Biologic DMARDs
Infliximab	5 mg/kg at 0, 2 and 6 wk followed by a maintenance regimen of 5 mg/kg every 8 wk
Adalimumab	80 mg initially, 40 mg on day 8, and 40 mg every other week thereafter
Etanercept	50 mg subcutaneously 2 times a week for 3 mo; (starting doses of 50 mg once a week have been shown to be effective); maintenance: 50 mg subcutaneously once a week
Golimumab12	50 mg once a month
Certolizumab pegol12	400 mg at 0, 2 and 4 wk followed by a maintenance regimen of 200 mg every other week
Ustekinumab3	45 mg initially, 45 mg at 4 wk, followed by a maintenance regimen of 45 mg every 12 wk3
Secukinumab2	300 mg at 0, 1, 2, 3, and 4 wk followed by a maintenance regimen of 300 mg every 4 wk. For some patients, a dose of 150 mg may be acceptable

¹Approved for adults with active psoriatic arthritis;

²No data available regarding the administration of patients with HBV or HCV;

³For patients weighing > 100 kg (220 lbs), the recommended dose is 90 mg initially, 90 mg at 4 wk, followed by a maintenance regimen of 90 mg every 12 wk. HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Diagnosis and distribution of patients treated with tumor necrosis factor-α inhibitors according to the hepatitis B virus serological profile

Ref.	Diagnosis, n	Inactive carriers (HBsAg+), n	Occult carriers or resolved HBV (anti-HBc+, anti-HBs- or anti-HBs ± anti-HBc), n	Prophylaxis2, n	Reactivation, n
Charpin et al[42]	PsA, 5	0	5	0	0
Prestinari et al[43]	PsO, 1	0	1	0	0
Nosotti et al[44]	PsO, 4; PsA, 3	1	6	1 (Lamivudine)	0
Caporali et al[45]	PsA, 4	0	4	0	0
Kim et al[46]	PsA, 2	0	2	0	0
Fotadiou et al[47]	PsO, 7	7	0	7 (Lamivudine)	0
Prignano et al[48]	PsO, 12	0	12	0	0
Cassano et al[49]	PsO, 28; PsA, 34	0	62	0	0
Cho et al[50]	PsA, 2	2	0	0	1
Navarro et al[51]	PsO, 13	0	13	0	0
Laurenti et al[52]	PsA, 8	1	7	1 (Lamivudine)	0
Navarro et al[53]	PsO, 4	4	0	3 (Lamivudine); 1 (adefovir2 entecavir)	0
1Sanz-Bueno et al[54]	PsO, 20	0	20	0	0

¹This group also includes 6 patients who received UTK;

²Only inactive carriers. PsO: Psoriasis; PsA: Psoriatic arthritis.

Table 3 Diagnosis and distribution of patients treated with ustekinumab according to the hepatitis B virus serological profile

Ref.	Diagnosis, n	Inactive carriers (HBsAg+), n	Occult carriers or resolved HBV (anti-HBc+, anti-HBs- or anti-HBs ± anti-HBc), n	Prophylaxis1, n	Reactivation, n
Navarro et al[53]	PsO 1	1	0	1 (Entecavir)	0
Chiu et al[60]	PsO 14	112	3	4 (Entecavir)	2
Hayashi et al[61]	PsO 5	0	5	0	0
Koskinas et al[62]	PsO 1	0	1	0	1
Steglich et al[63]	PsO 1	0	1	1 (Lamivudine)	0

¹Only inactive carriers;

²Six with diagnosis of chronic hepatitis. PsO: Psoriasis; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; HBc: Hepatitis B core.

Table 4 Diagnosis and laboratory characteristics of reported psoriatic patients with chronic hepatitis B virus infection treated with tumor necrosis factor-α inhibitors

Ref.	Diagnosis, n	Concomitant HCV therapy, n	ALT outcomes at last follow-up compared to baseline, n	HCV viral load outcome at last follow-up compared to baseline, n
Khanna et al[80]	PsA, 1	1 (N/A)	1 (N/A)	1 (N/A)
Magliocco et al[81]	PsA, 3	0	3 (=)	2 (↓); 1(N/A)
Cecchi et al[82]	PsO, 1	0	1 (=)	1 (=)
De Simone et al[83]	PsO, 2	0	2 (=)	2 (↓)
Asladinis et al[84]	PsA, 1	0	1 (=)	1 (↓)
Rokshar et al[85]	PsO, 1	0	1 (N/A)	1 (=)
Pitarch et al[86]	PsA, 1	1 (N/A)	1 (=)	1 (N/A)
Linadarki et al[87]	PsA, 1	0	1 (=)	1 (=)
Alcaide et al[88]	PsO, 1	0	1 (=)	1 (=)
Piccolo et al[89]	PsO, 1	0	1 (↑)	1 (↓)
Collazzo et al[90]	PsO, 1	0	1 (=)	1 (N/A)
Cassano et al[91]	PsO, 1	0	1 (=)	1 (=)
Cavazzana et al[92]	PsA, 1	0	1 (=)	1 (=)
Behnam et al[93]	PsO, 1	1 (IFN + Rib)	1 (↓)	1 (↓)
Ventura et al[94]	PsO, 1; PsA, 1	0	2 (↓)	1 (↑); 1 (↓)
Paradisi et al[95]	PsA, 2	0	2 (=)	2 (=)
Prignano et al[96]	PsO, 1	0	1 (N/A)	1 (=)
Richetta et al[97]	PsO, 11	0	1 (N/A)	1 (N/A)
Garavaglia et al[98]	PsO, 3; PsA, 2	1 (IFN + Rib)	1 (=); 4 (↓)	3 (=); 1 (↓)
Gandhi et al[99]	PsO, 1	0	1 (↓)	1 (↓)
Di Lernia et al[100]	PsO, 13	0	1 (=)	1 (=)
Zanni et al[101]	PsA, 3	0	3 (=)4	3 (=)
Prignano et al[48]	PsO, 6	0	6 (=)	6 (=)
Mederacke et al[102]	PsA, 1	1 (IFN + Rib)	1 (N/A)	1 (↓)
Navarro et al[53]	PsO, 202	3 (IFN + Rib)	See references	See references
Bartalesi et al[103]	PsO, 1	1 (IFN + Rib)	1 (↓)	1 (↓)
Costa L et al[104]	PsA, 15	0	13 (=); 2 (↓)	14 (=); 1 (↓)
Di Nuzzo et al[105]	PsA, 2	1 (IFN + Rib)	1 (=); 1 (↓)	2 (↓)
Salvi et al[106]	PsO, 1	0	1 (↑)	1 (=)

¹1 erythrodermic psoriasis;

²1 erythrodermic psoriasis, 2 palmoplantar psoriasis;

³1 palmoplantar psoriasis;

⁴1 patient with concomitant alcoholic hepatitis. PsO: Psoriasis; PsA: Psoriatic arthritis; =: No significant change; ↓: Decreased; ↑: Increased; N/A: Not available; IFN: Interferon; Rib: Ribavirine.