Patients with hepatitis B and C virus infections should be screened for risk before receiving antipsoriatic therapy, according to a study published by the American Journal of Clinical Dermatology.
“The risk of HBV reactivation can be defined as: high risk (10% or more), moderate risk (1% to 10%) and low risk (less than 1%) depending on the type of immunosuppressive therapy stratified by the presence or absence of hepatitis B surface antigen but positivity to anti-hepatitis B core antigen,” Stefano Piaserico, MD, of the department of medicine at the University of Padova in Padua, Italy, and colleagues wrote.
Researchers evaluated data collected on traditional and newly developed drugs used to treat patients with psoriasis, HBV and HCV infection.
Results showed that patients positive for hepatitis B surface antigen prescribed methotrexate, acitretin or Otezla (apremilast, Celgene) have a low risk of reactivation but should be monitored by determining alanine aminotransferase and HBV DNA levels every 3 months. These patients have a high or moderate risk of HBV reactivation if treated with tumor necrosis factor-alpha inhibitors, Stelara (ustekinumab, Janssen) or cyclosporine. These patients should be considered possible candidates for prophylactic anti-HBV therapy.
Patients positive for anti-hepatitis B core antigen treated with tumor necrosis factor-alpha inhibitors, ustekinumab and cyclosporine have a moderate risk of reactivation and should undergo HBV DNA or hepatitis B surface antigen and alanine aminotransferase testing than therapies. Those positive for anti-hepatitis B core antigen treated with methotrexate, acitretin or apremilast have a low risk of reactivation and do not require therapies or monitoring.
There is no conclusive data for interleukin-17 and interleukin-23 inhibitors for either of these variables.
“All dermatologists should master the pathogenesis and risk assessment of these preventable complications to provide the best and safest treatment for patients with psoriasis,” the researchers wrote.
Researchers suggest further studies with larger numbers of cases to help clarify the uncertainties and questions that remain on the use of these therapies in individuals with concomitant psoriasis and HBV or HCV infections. These studies will help physicians in managing these patients. – by Erin T. Welsh
Disclosures: Piaserico reports consulting for AbbVie, Almirall, Celgene, Janssen-Cilag, Lilly, MSD, Novartis and Pfizer. Please see the study for all other authors’ relevant financial disclosures.