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

Raducan,Anca; Bucur,Stefana; Caruntu,Constantin; Constantin,Traian; Nita,Iuliana Elena; Manolache,Nicuta; Constantin,Maria-Magdalena

doi:10.3892/etm.2019.7567

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

Authors:
- Anca Raducan
- Stefana Bucur
- Constantin Caruntu
- Traian Constantin
- Iuliana Elena Nita
- Nicuta Manolache
- Maria-Magdalena Constantin
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Affiliations: Dr. Anca Răducan Anti-Aging Dermatology Clinic, 900705 Constanta, Romania, The Second Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania, Department of Dermatology, Prof. ‘N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 021106 Bucharest, Romania , Department of Urology, ‘Prof. Dr. Th. Burghele’ Hospital, 050659 Bucharest, Romania, Department of Dermatology, Faculty of Pharmacological Sciences, ‘Dunarea de Jos’ University of Medicine and Pharmacy, 800201 Galati, Romania
Published online on: May 9, 2019 https://doi.org/10.3892/etm.2019.7567
Pages: 895-899

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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 2x50 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.

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