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. 2019 Aug;18(2):895-899.
doi: 10.3892/etm.2019.7567. Epub 2019 May 9.

Therapeutic management with biological anti-TNF-α agent in severe psoriasis associated with chronic hepatitis B: A case report

Anca Raducan  1 , Stefana Bucur  2 , Constantin Caruntu  3 , Traian Constantin  4 , Iuliana Elena Nita  2 , Nicuta Manolache  5 , Maria-Magdalena Constantin  2   6
Affiliations

Therapeutic management with biological anti-TNF-α agent in severe psoriasis associated with chronic hepatitis B: A case report

Anca Raducan et al. Exp Ther Med. 2019 Aug.

Abstract

Systemic therapy in patients with concurrent psoriasis and chronic hepatitis B is a challenging task for both dermatologists and gastroenterologists since there is a high risk for hepatitis B virus (HBV) reactivation and hepatic toxicity under biological therapy. The therapeutic management of a patient with psoriasis and infection with the HBV is a challenge as the classical systemic treatment (methotrexate, acitretin, cyclosporine) shows a high risk of immunosuppression and/or hepatic toxicity and the biological therapy is endangered by the possibility of HBV reactivation. We present the case of a patient with moderate-severe psoriasis and chronic hepatitis B for whom we assessed the risk-benefit relation and considered useful to initiate the anti-TNF therapy concomitantly with the antiviral therapy with entecavir. The therapeutic algorithm included initiation of anti-TNF therapy with etanercept 2×50 mg/week combined with entecavir, an antiviral treatment administered continuously since the diagnosis of the HBV hepatitis, with hepatic function and viral load monitoring. After 3 months of therapy with etanercept the patient was given a dose of etanercept of 50 mg/week combined with entecavir 0.5 mg/day which he continued until week 36 when psoriatic lesions had cleared (PASI=0.6; DLQI=0). No adverse effects were registered and there was no evidence of HBV viral replication or changes in viral markers. We wish to emphasize that the use of etanercept in a patient with psoriasis and hepatitis B is a successful therapeutic alternative which may be safely used concomitantly with entecavir, with regular monitoring of viral load and hepatic function tests.

Keywords: anti-TNF-α agent; chronic hepatitis B; entecavir; etanercept; psoriasis.

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Figures

Figure 1.
Figure 1.
Infiltrated lesions, with thick white scales, easily detachable, distributed over the elbow and forearm.
Figure 2.
Figure 2.
Erythemato-squamous circumscribed plaques, outlined by the hair line.
Figure 3.
Figure 3.
Subungual hyperkeratosis, distal onycholisys, pitting, yellow discoloration and multiple horrizontal lines.
Figure 4.
Figure 4.
PASI and DLQI in dynamics. PASI, Psoriasis Area and Severity Index; DLQI, Dermatology Life Quality Index.
Figure 5.
Figure 5.
The evolution of psoriatic lesions.
See this image and copyright information in PMC

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