NEW ORLEANS — Etanercept appears to be a safe therapeutic option in psoriasis patients with concurrent hepatitis C, according to the results of a retrospective case series.
“Not only does it appear to be safe, it might even be beneficial for the patient's underlying hepatitis,” Erin J. Allen, M.D., proposed during a poster presentation at the annual meeting of the American Academy of Dermatology.
Hepatitis viral loads decreased in two of the five patients receiving etanercept (Enbrel) 25 mg twice weekly for up to 14 months. Three patients had decreased liver transaminases.
Of the two patients with elevated transaminases, one discontinued interferon prematurely just before starting etanercept, so the worsening transaminases were not unexpected, said Dr. Allen, a dermatologist at St. Louis University. In the other patient, a significant elevation was noted only in alanine transaminase and not in the transaminase levels.
All patients showed marked improvement of their psoriasis, with three of the five patients becoming “clear” or “almost clear” on the physicians' global assessment.
Two patients experienced a flare when started on interferon, but still tolerated the interferon, and psoriasis remained less than 10% of body surface area.
Etanercept, an anti-tumor necrosis factor (TNF) therapy, was a rational choice for these patients because TNF is elevated in both hepatitis C and psoriasis, said Dr. Allen, who has participated in etanercept trials, but didn't receive funding for the series.
Although the exact mechanism is not known, etanercept neutralizes the proinflammatory effects of TNF by preventing soluble TNF-α and TNF-β from binding to their receptors.
The case series joins a very limited amount of literature evaluating the use of etanercept (Enbrel) in patients with rheumatoid arthritis (RA) or psoriasis and concurrent hepatitis C (HCV).
According to the literature, treatment with etanercept did not worsen the underlying hepatitis in three psoriasis patients (J. Am. Acad. Dermatol. 2004;51:580–4) and improved the serum transaminases and viral loads in some patients with RA and HCV (J. Dermatolog. Treat. 2003;14:229–32).
Although etanercept was generally well tolerated, Dr. Allen recommended that all psoriasis patients with concurrent hepatitis C be closely monitored in conjunction with a hepatologist until more data are available.