Review
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World J Dermatol. Nov 2, 2014; 3(4): 76-85
Published online Nov 2, 2014. doi: 10.5314/wjd.v3.i4.76
Psoriasis: Biologic treatment and liver disease
Eva Vilarrasa, Luis Puig
Eva Vilarrasa, Luis Puig, Psoriasis Unit, Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
Author contributions: All authors contributed to this paper; Vilarrasa E designed and wrote the paper; Puig L reviewed the manuscript.
Correspondence to: Eva Vilarrasa, MD, Physician Staff, Psoriasis Unit, Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/ Sant Antoni Maria Claret 167, 08025 Barcelona, Spain. evilarrasa@santpau.cat
Telephone: +34-93-5537007 Fax: +34-93-5537008
Received: December 29, 2013
Revised: August 28, 2014
Accepted: September 16, 2014
Published online: November 2, 2014
Processing time: 319 Days and 7.6 Hours
Abstract

Patients with moderate or severe psoriasis have a high prevalence of chronic liver disease. Chronic liver disease in these patients is related to metabolic syndrome, alcohol abuse or viral infections. Therefore, treatment of these patients is challenging. Classic systemic treatments may be contraindicated because of their immunosuppressive and hepatotoxic potential. First-line therapy in this setting is generally ultraviolet B phototherapy combined with topical treatment, but its feasibility and efficacy are sometimes limited. The therapeutic options are further restricted by concomitant psoriatic arthritis. Biologic treatments have shown to be effective in psoriasis and psoriatic arthritis, and they are largely devoid of liver toxicity. Anti-tumor necrosis factor-alpha (TNF-α) treatments have proven to be effective and safe in patients with chronic hepatitis C virus (HCV) infections and other non-infectious chronic liver disorders, including alcoholic and non-alcoholic liver diseases. However, in chronic hepatitis B virus (HBV), anti-TNF-α treatments carry a potential risk of HBV reactivation. Anti-interleukin-12/23 treatments are also effective in patients with psoriasis, but data regarding their safety in chronic hepatitis infections are still limited. Safety reports in patients with psoriasis and chronic HCV infection are contradictory, and in chronic HBV evidence indicate a high risk of viral reactivation. Moreover, concerns remain about the long-term safety of both TNF-α antagonists and ustekinumab. Non-viral liver diseases such as alcoholic and non-alcoholic liver diseases are more prevalent in patients with psoriasis than in the general population. TNF-α antagonists have also been prescribed in these patients. Although data are still scarce in this setting, results suggest a favorable profile in patients with psoriasis and non-alcoholic liver diseases. We review the literature regarding all these aspects.

Keywords: Psoriasis; Liver disease; Biologic; Anti-tumor necrosis factor-alpha; Ustekinumab; Chronic hepatitis C; Chronic hepatitis B; Alcoholic liver disease; Non-alcoholic fatty liver disease

Core tip: We review and summarize the published data regarding the efficacy and safety of anti-tumor necrosis factor-alpha and anti-interleukin-12/23 therapies in patients with psoriasis and liver diseases, with special reference to hepatitis C, hepatitis B, non-alcoholic fatty liver disease, and fatty liver disease. Data collected and revised up to December 2013.