MedWire News: Topical therapy and ultraviolet B (UVB) phototherapy should be considered first-line and second-line therapies for patients with limited psoriasis and concomitant hepatitis C virus (HCV) infection, suggests a consensus report from the Medical Board of the US National Psoriasis Foundation.
On behalf of the Foundation, Alice Gottlieb, from Tufts Medical Center in Washington, Boston, USA, and colleagues reviewed the medical literature for studies on psoriasis treatment in patients with HCV.
“Treating patients with psoriasis and HCV infection is complicated because psoriasis can be triggered or worsened by interferon alfa, which is a standard of care for HCV,” Gottlieb et al explain.
“Furthermore, the majority of systemic therapies for psoriasis may be hazardous in patients with HCV infection.”
The researchers found that there were few evidence-based studies on the treatment of psoriasis with systemic therapy in patients with pre-existing liver disease, and call for more large double-blinded clinical trials.
Nevertheless, from the evidence available, they say that topical agents are usually well tolerated by psoriasis patients with concomitant HCV and should be a first-line therapy for patients with limited psoriasis.
UVB phototherapy has been found unlikely to cause ill effects in HCV patients and is recommended as a suitable second-line therapy in patients with limited psoriasis and as a first-line therapy for patients with more extensive disease that makes applying topical therapy impractical.
Psoralen plus UVA therapy should be considered as a second-line therapy but only in patients with moderate-to-severe psoriasis. No studies have been conducted in patients with psoriasis and HCV, but studies examining liver biopsy specimens suggest that this treatment is not hepatotoxic.
Other second-line therapies for patients with moderate-to-severe psoriasis include acitretin and the tumor necrosis factor (TNF)-α inhibitors etanercept, infliximab, and adalimumab. Small studies have shown that chronic HCV infection is not a contraindication to TNF-α inhibitors.
The systemic therapies alefacept, cyclosporine, and efalizumab should only be considered third-line therapy for patients with moderate-to-severe psoriasis and concomitant HCV, as little evidence exists.
Mycophenolate mofetil should not be used to treat psoriasis in patients with concomitant HCV, the researchers advise, as it too potent an immunosuppressive for such patients.
They also recommend that HCV loads should be measured in psoriasis patients with concomitant HCV before and periodically during treatment, and liver function tests carried out.
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