1
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Shu X, Chen XX, Kang XD, Ran M, Wang YL, Zhao ZK, Li CX. Identification of potential key molecules and signaling pathways for psoriasis based on weighted gene co-expression network analysis. World J Clin Cases 2022; 10:5965-5983. [PMID: 35949853 PMCID: PMC9254198 DOI: 10.12998/wjcc.v10.i18.5965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease, the pathogenesis of which is more complicated and often requires long-term treatment. In particular, moderate to severe psoriasis usually requires systemic treatment. Psoriasis is also associated with many diseases, such as cardiometabolic diseases, malignant tumors, infections, and mood disorders. Psoriasis can appear at any age, and lead to a substantial burden for individuals and society. At present, psoriasis is still a treatable, but incurable, disease. Previous studies have found that microRNAs (miRNAs) play an important regulatory role in the progression of various diseases. Currently, miRNAs studies in psoriasis and dermatology are relatively new. Therefore, the identification of key miRNAs in psoriasis is helpful to elucidate the molecular mechanism of psoriasis.
AIM To identify key molecular markers and signaling pathways to provide potential basis for the treatment and management of psoriasis.
METHODS The miRNA and mRNA data were obtained from the Gene Expression Omnibus database. Then, differentially expressed mRNAs (DEmRNAs) and differentially expressed miRNAs (DEmiRNAs) were screened out by limma R package. Subsequently, DEmRNAs were analyzed for Gene Ontology and Kyoto Encyclopedia of Genes and Genomics functional enrichment. The “WGCNA” R package was used to analyze the co-expression network of all miRNAs. In addition, we constructed miRNA-mRNA regulatory networks based on identified hub miRNAs. Finally, in vitro validation was performed. All experimental procedures were approved by the ethics committee of Chinese PLA General Hospital (S2021-012-01).
RESULTS A total of 639 DEmRNAs and 84 DEmiRNAs were identified. DEmRNAs screening criteria were adjusted P (adj. P) value < 0.01 and |logFoldChange| (|logFC|) > 1. DEmiRNAs screening criteria were adj. P value < 0.01 and |logFC| > 1.5. KEGG functional analysis demonstrated that DEmRNAs were significantly enriched in immune-related biological functions, for example, toll-like receptor signaling pathway, cytokine-cytokine receptor interaction, and chemokine signaling pathway. In weighted gene co-expression network analysis, turquoise module was the hub module. Moreover, 10 hub miRNAs were identified. Among these 10 hub miRNAs, only 8 hub miRNAs predicted the corresponding target mRNAs. 97 negatively regulated miRNA-mRNA pairs were involved in the miRNA-mRNA regulatory network, for example, hsa-miR-21-5p-claudin 8 (CLDN8), hsa-miR-30a-3p-interleukin-1B (IL-1B), and hsa-miR-181a-5p/hsa-miR-30c-2-3p-C-X-C motif chemokine ligand 9 (CXCL9). Real-time polymerase chain reaction results showed that IL-1B and CXCL9 were up-regulated and CLDN8 was down-regulated in psoriasis with statistically significant differences.
CONCLUSION The identification of potential key molecular markers and signaling pathways provides potential research directions for further understanding the molecular mechanisms of psoriasis. This may also provide new research ideas for the prevention and treatment of psoriasis in the future.
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Affiliation(s)
- Xin Shu
- Department of Dermatology, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Xiao-Xia Chen
- Department of Radiology, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Xin-Dan Kang
- Department of Comprehensive Surgical, The Second Medical Center of Chinese PLA General Hospital, Beijing 100089, China
| | - Min Ran
- Department of Endocrine, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - You-Lin Wang
- Department of Dermatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Zhen-Kai Zhao
- Department of Dermatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Cheng-Xin Li
- Department of Dermatology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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2
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Zhou S, Yao Z. Roles of Infection in Psoriasis. Int J Mol Sci 2022; 23:ijms23136955. [PMID: 35805960 PMCID: PMC9266590 DOI: 10.3390/ijms23136955] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated disorder with cutaneous and systemic manifestations. Genetic predisposition, environmental factors, and immune dysfunction all contribute to the pathogenesis of psoriasis with host-microbe interaction governing the progression of this disease. Emerging evidence has indicated that infection is an environmental trigger for psoriasis and plays multiple roles in its maintenance as evidenced by the frequent association between guttate psoriasis onset and acute streptococcal infection. Different infectious factors act on immune cells to produce inflammatory cytokines that can induce or aggravate psoriasis. In addition to bacterial infections, viral and fungal infections have also been shown to be strongly associated with the onset or exacerbation of psoriasis. Intervention of skin microbiota to treat psoriasis has become a hot research topic. In this review, we summarize the effects of different infectious factors (bacteria, viruses, and fungi) on psoriasis, thereby providing insights into the manipulation of pathogens to allow for the identification of improved therapeutic options for the treatment of this condition.
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Affiliation(s)
- Shihui Zhou
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China;
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China;
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Correspondence:
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3
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Motolese A, Ceccarelli M, Macca L, Li Pomi F, Ingrasciotta Y, Nunnari G, Guarneri C. Novel Therapeutic Approaches to Psoriasis and Risk of Infectious Disease. Biomedicines 2022; 10:biomedicines10020228. [PMID: 35203438 PMCID: PMC8869084 DOI: 10.3390/biomedicines10020228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
Psoriasis is a chronic immune-mediated skin and joint disease, with a plethora of comorbidities, characterized by a certain genetic predisposition, and a complex pathogenesis based on the IL-23/IL-17 pathway. There is no doubt that the patients affected by psoriasis are more susceptible to infections as well as that the risk of infection is higher in psoriatic subjects than in the general population. The advent of biotechnological agents on the therapeutic arsenal actually available for the treatment of moderate-to-severe patients, given the fact that the severity of the disease is a predictor of the level of infectious risk, has raised the question of whether these ‘new’ drugs could be considered a safer option and how they can be used in selected cases. Old and newer strategies in cases of chronic infectious conditions are reviewed under the light of clinical trials and other studies present in literature.
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Affiliation(s)
- Alfonso Motolese
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, Catania, Italy C/O ARNAS “Garibaldi”, “Nesima” Hospital, via Palermo 636, 95122 Catania, Italy;
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
| | - Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; (A.M.); (L.M.); (F.L.P.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Pharmacology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy;
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98124 Messina, Italy;
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy C/O A.O.U.P. “Gaetano Martino”, via Consolare Valeria, 1, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-090-2212-894; Fax: +39-09-029-27691
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4
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Ma SH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Association between hepatitis C virus infection and subsequent chronic inflammatory skin disease. J Dermatol 2021; 48:1884-1891. [PMID: 34460962 DOI: 10.1111/1346-8138.16129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
Hepatitis C virus (HCV) infection is associated with several cutaneous manifestations, including lichen planus and psoriasis. However, its association with other chronic inflammatory skin diseases (CISD) remains largely unknown. The aim of this study was to investigate the association between HCV infection and CISD. Participants were recruited from the National Health Insurance Research Database in Taiwan. Altogether 23 509 patients with HCV infection and 94 036 matched controls were included to assess the risk of CISD. A Cox regression model was used for the analyses. Compared with controls, patients with HCV infection had an adjusted hazard ratio (aHR) of 6.34 (95% confidence interval [CI], 5.30-7.58) for CISD after adjustment for potential confounders. Regarding individual CISD, patients with HCV infection had a significantly increased risk of developing lichen planus, psoriasis, vitiligo, alopecia areata, and cutaneous lupus erythematosus. Interferon-based antiviral therapy (IFN-based AVT) was significantly associated with a decreased risk of CISD (aHR = 0.42; 95% CI, 0.28-0.64). Patients with HCV infection had a significantly increased risk of CISD, while IFN-based AVT was associated with a decreased risk. These findings suggest monitoring of CISD in patients with HCV infection.
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Affiliation(s)
- Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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5
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Liu Y, Cui SN, Duan MY, Dou ZL, Li YZ, Liu YX, Xia Y, Zhang JW, Yan XN, Han DR. Is there a relationship between psoriasis and hepatitis C? A meta-analysis and bioinformatics investigation. Virol J 2021; 18:135. [PMID: 34215260 PMCID: PMC8252322 DOI: 10.1186/s12985-021-01606-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
Background The relationship between psoriasis and hepatitis C was previously controversial, so our purpose is to investigate this connection.
Methods We conducted a systematic review of the case–control, cross-sectional and cohort studies examining the association between psoriasis and hepatitis C in PubMed, EMBASE and Cochrane library databases and investigated the overlapping genes between psoriasis targets and hepatitis C targets using bioinformatics analysis. Based on overlapping genes and hub nodes, we also constructed the protein–protein interaction (PPI) network and module respectively, followed by the pathway enrichment analysis.
Results We included 11 publications that reported a total of 11 studies (8 cross-sectional and 3 case–control). The case–control and cross-sectional studies included 25,047 psoriasis patients and 4,091,631 controls in total. Psoriasis was associated with a significant increase of prevalent hepatitis C (OR 1.72; 95% confidence interval [CI] (1.17–2.52)). A total of 389 significant genes were common to both hepatitis C and psoriasis, which mainly involved IL6, TNF, IL10, ALB, STAT3 and CXCL8. The module and pathway enrichment analyses showed that the common genes had the potential to influence varieties of biological pathways, including the inflammatory response, cytokine activity, cytokine–cytokine receptor interaction, Toll-like receptor signaling pathway, which play an important role in the pathogenesis of hepatitis C and psoriasis. Conclusion Patients with psoriasis display increased prevalence of hepatitis C and the basic related mechanisms between hepatitis C and psoriasis had been preliminarily clarified. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-021-01606-z.
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Affiliation(s)
- Yong Liu
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China.,Department of Dermatology, Shaanxi Hospital of Chinese Medicine, Xi'an, China
| | - Sheng Nan Cui
- Department of Dermatology, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, China
| | - Meng Yao Duan
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi Li Dou
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Zhen Li
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Xing Liu
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Ye Xia
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Wei Zhang
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Ning Yan
- Department of Dermatology, Shaanxi Hospital of Chinese Medicine, Xi'an, China.
| | - Dong Ran Han
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China.
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6
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Cohen JM, Kridin K, Perez-Chada LM, Merola JF, Cohen AD. Hepatitis B and C among patients with hidradenitis suppurativa: a population-based study. Int J Dermatol 2021; 61:84-88. [PMID: 33998670 DOI: 10.1111/ijd.15578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory condition related to multiple systemic diseases and infections. METHODS This retrospective cross-sectional study from 1999 to 2015 used the database of Clalit Health Services, the largest managed care organization in Israel, to explore the association between HS and hepatitis B and C. Sociodemographic and clinical information was compared using χ2 tests for sex and socioeconomic status and t-tests for age. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to compare the odds of hepatitis B and C in those with and without HS. RESULTS In multivariate analysis controlling for sex, age as a continuous variable, Arab ancestry, and history of drug abuse, HS was associated with a 1.87-fold increased odds (95% CI 1.11-3.17, P = 0.019) of hepatitis B (HBV). HS was also associated with HCV in multivariate analysis controlling for sex, age per year, Arab ancestry, alcohol use, and drug use, with a 1.74-fold increased odds (95% CI 1.05-2.89, P = 0.032) of hepatitis C (HCV) among those with HS as compared to controls. CONCLUSIONS This study demonstrated an association between HS and both hepatitis B and hepatitis C.
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Affiliation(s)
- Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Khalaf Kridin
- Department of Dermatology, Rambam Health Campus, Haifa, Israel
| | - Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Divsion of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arnon D Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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7
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Arafa A, Mostafa A. Association of hepatitis B virus infection and psoriasis: A meta‐analysis. Australas J Dermatol 2020; 61:382-384. [DOI: 10.1111/ajd.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed Arafa
- Public health Department of Social Medicine Osaka University Graduate School of Medicine Osaka Japan
- Department of Public Health Faculty of Medicine Beni‐Suef University Beni‐Suef Egypt
| | - Alshimaa Mostafa
- Department of Dermatology Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Dermatology Faculty of Medicine Beni‐Suef University Beni‐Suef Egypt
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8
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The Risk of Systemic Diseases in Those with Psoriasis and Psoriatic Arthritis: From Mechanisms to Clinic. Int J Mol Sci 2020; 21:ijms21197041. [PMID: 32987907 PMCID: PMC7583918 DOI: 10.3390/ijms21197041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023] Open
Abstract
Psoriasis and psoriatic arthritis (PsA) have been recently considered as chronic systemic inflammatory disorders. Over the past decades, enormous evidence indicates that patients with psoriasis and PsA have a higher risk of developing various comorbidities including cardiovascular disease, metabolic disease, cancers, infections, autoimmune disease, and psychiatric diseases. However, reported risks of some comorbidities in those with psoriasis and PsA are somewhat different according to the research design. Moreover, pathomechanisms underlying comorbidities of those with psoriasis and PsA remain poorly elucidated. The purpose of this review is to provide the most updated comprehensive view of the risk of systemic comorbidities in those with psoriasis and PsA. Molecular mechanisms associated with the development of various comorbidities in those with psoriasis and PsA are also reviewed based on recent laboratory and clinical investigations. Identifying the risk of systemic comorbidities and its associated pathomechanisms in those with psoriasis and PsA could provide a sufficient basis to use a multi-disciplinary approach for treating patients with psoriasis and PsA.
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9
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El-Komy MHM, Mashaly H, Sayed KS, Hafez V, El-Mesidy MS, Said ER, Amer MA, AlOrbani AM, Saadi DG, El-Kalioby M, Eid RO, Azzazi Y, El Sayed H, Samir N, Salem MR, El Desouky ED, Zaher HAEM, Rasheed H. Clinical and epidemiologic features of psoriasis patients in an Egyptian medical center. JAAD Int 2020; 1:81-90. [PMID: 34409325 PMCID: PMC8362248 DOI: 10.1016/j.jdin.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
Background Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. Objective To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. Methods This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. Results The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. Limitations Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. Conclusions This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.
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Affiliation(s)
- Mohamed Hussein Medhat El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Mashaly
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khadiga S Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa S El-Mesidy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman R Said
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa A Amer
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya M AlOrbani
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona El-Kalioby
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem O Eid
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yousra Azzazi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hagar El Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nesrin Samir
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa R Salem
- Department of Public Health and Community, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman D El Desouky
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hesham Abd El-Moaty Zaher
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rasheed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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10
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Wu JJ, Merola JF, Feldman SR, Menter A, Lebwohl M. Treatment of Psoriasis with Secukinumab in Challenging Patient Scenarios: A Review of the Available Evidence. Dermatol Ther (Heidelb) 2020; 10:351-364. [PMID: 32242325 PMCID: PMC7211772 DOI: 10.1007/s13555-020-00373-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 01/06/2023] Open
Abstract
Psoriasis (PsO) is a common, systemic, chronic, inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling. PsO is associated with a high prevalence of comorbidities, including other autoimmune diseases and malignancies. Furthermore, special populations, such as pregnant, pediatric, and elderly patients, and those with erythrodermic PsO, are challenging to treat and require tightly monitored disease and treatment management. Because certain populations have demographic or clinical characteristics that can affect the presentation of PsO and complicate treatment responses, these patient populations are largely excluded from clinical trials; therefore, most clinical evidence for the treatment of these patients is derived from case reports and series. Secukinumab, a fully human monoclonal interleukin-17A antibody, has been shown in several clinical trials to be effective and safe for the treatment of PsO; however, these studies offer only limited data on the use of secukinumab in patients with chronic illnesses or in special populations. This review explores the use of secukinumab for PsO in special populations, including pregnant women, children, elderly people, patients with erythrodermic PsO, and those with chronic illnesses, including latent tuberculosis, hepatitis B and C, HIV, multiple sclerosis, and malignancies.
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Affiliation(s)
- Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA.
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan Menter
- Baylor Scott & White Health, Dallas, TX, USA
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11
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Factors associated with psoriasis in a French Nationwide HIV cohort: the independent role of HLA-B*57:01. AIDS 2020; 34:1057-1063. [PMID: 32167971 DOI: 10.1097/qad.0000000000002519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Psoriasis is a T-cell-mediated inflammatory disease with genetic factors involved in its etiopathogenesis. In non-HIV populations, HLA-B57:01 has been associated with a higher risk of psoriasis. The aim of this study was to investigate demographic and immunovirological characteristics associated with psoriasis, and to assess whether HLA-B57:01 is associated with psoriasis among people living with HIV (PLHIV) followed in a large French multicenter Dat'AIDS cohort. METHODS All PLHIV followed up from January 2000 to December 2018 with an available result for HLA-B57:01 were included. Logistic regression models were used to identify associations between psoriasis (outcome variable) and explanatory variables. RESULTS Among 31 076 PLHIV, the overall prevalence of psoriasis and HLA-B57:01 were 2.25 and 4.73%, respectively and varied according to ethnicity. By multivariate analysis, male gender [OR 1.81 (95% CI 1.46-2.24), P < 10], positive HLA-B57:01 [OR 2.66 (95% CI 2.12-3.33), P < 10], nadir CD4 cell count less than 200 cells/μl [OR 1.41 (95% CI 1.19-1.67), P < 10] and positive HCV serology [OR 1.45 (95% CI 1.20-1.76), P < 10] were significantly associated with a higher risk of psoriasis. Being born in West and Central Africa [OR 0.15 (95% CI 0.10-0.25), P < 10], the Caribbean islands [OR 0.14 (95% CI 0.05-0.45), P = 0.0008] or Latin America [OR 0.31 (95% CI 0.14-0.69), P = 0.004] was associated with a lower risk of psoriasis compared with patients born in mainland France. CONCLUSION PLHIV carrying HLA-B57:01 have around a three-fold increased risk of psoriasis. This association might provide a possible explanation for the observed differences in psoriasis prevalence between ethnic groups.
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12
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Chularojanamontri L, Nimanong S, Wongpraparut C, Silpa-Archa N, Chaiyabutr C, Charoenpipatsin N. How do we treat psoriasis patients with hepatitis C infections in real-world situations? A retrospective analysis of 34 patients. J DERMATOL TREAT 2019; 32:321-327. [PMID: 31418622 DOI: 10.1080/09546634.2019.1657225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is still relatively limited data on psoriasis and hepatitis C virus (HCV) infections. OBJECTIVE This study investigated the clinical characteristics and treatment of psoriasis patients with HCV infections in real-world practice. METHODS Medical records of all psoriasis patients with HCV infections who attended the outpatient clinic at Siriraj Hospital over a 10-year period were retrospectively reviewed. RESULTS Of 34 patients, 26 and 8 patients were men and women, respectively with a mean age of 57.0 ± 8.7 (range, 42.2-77.2) years. The median age of psoriasis onset was 42.7 ± 12.7 (range, 8-67.25) years. With a median follow-up period of 13.6 years, cirrhosis and hepatocellular carcinoma were found in 67.6% and 29.4% of the patients, respectively. The interferon used for HCV treatment exacerbated the psoriasis in 20% of those patients. Conventional treatments and anti-tumor necrosis factors (anti-TNFs) were used in strict collaboration with hepatologists. No patients experienced a worsening of their HCV infection. CONCLUSION Despite a limited number of patients, a male predominance and late-onset psoriasis were frequently observed. Although, interferon therapy for HCV can exacerbate psoriasis, it is not contraindicated. All conventional treatments and anti-TNFs can be used, provided that there is strict collaboration with hepatologists.
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Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supot Nimanong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Norramon Charoenpipatsin
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Lee H, Patel K, Singam V, Rastogi S, Silverberg J. Associations of cutaneous and extracutaneous infections with hidradenitis suppurativa in U.S. children and adults. Br J Dermatol 2019; 182:327-334. [DOI: 10.1111/bjd.18093] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Affiliation(s)
- H.H. Lee
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - K.R. Patel
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - V. Singam
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - S. Rastogi
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - J.I. Silverberg
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
- Department of Dermatology, Preventive Medicine and Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center Chicago IL U.S.A
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14
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Kibari A, Cohen AD, Gazitt T, Bitterman H, Lavi I, Feldhamer I, Shalom G, Greenberg-Dotan S, Zisman D. Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study. Clin Rheumatol 2019; 38:2069-2075. [PMID: 30937638 DOI: 10.1007/s10067-019-04528-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence of risk factors associated with cardiovascular disease (CVD) and CVD-related morbidity in a large Middle-Eastern psoriatic arthritis (PsA) cohort. METHOD A retrospective case control study was conducted using Israel's largest health care provider's patient database from 2000 to 2013. For each patient with PsA, 10 patients with no history of psoriasis or arthritis were matched for age and sex. Analysis of CVD-related risk factors and morbidity included hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus type 2 (DM-2), obesity, smoking, ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular accident (CVA), carotid artery disease, peripheral vascular disease (PVD), aortic aneurism, valvular heart disease (VHD), and cardiomyopathy. Statistical analysis was conducted using t test and chi-square tests as appropriate. Univariate and multivariable logistic regression models assessed the association between PsA and CVD-related risk factors and morbidity. RESULTS Three thousand one hundred sixty-one PsA patients were included, with average age 58 ± 15.0 years, of whom 53.4% were women. Increased prevalence of DM-2, HLD, HTN, and obesity (OR 1.7, 1.5, 1.5, 1.5 respectively) was noted in the PsA group. Increased prevalence of IHD (p < 0.0001), PVD (p < 0.0001), CHF (p = 0.002), VHD (p < 0.0001), and cardiomyopathy (p = 0.006) was found in the PsA group compared to the control group even after adjusting for CVD risk factors. CONCLUSIONS A high prevalence of CVD-related risk factors and morbidity was found in this Middle Eastern PsA population, in accordance with data from other geographic regions. These results emphasize the importance of clinician awareness of the increased risk for CVD-related complications in PsA patients.
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Affiliation(s)
- Adi Kibari
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Haim Bitterman
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Guy Shalom
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Sari Greenberg-Dotan
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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15
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Romano C, Cuomo G, Ferrara R, Del Mastro A, Esposito S, Sellitto A, Adinolfi LE. Uncommon immune-mediated extrahepatic manifestations of HCV infection. Expert Rev Clin Immunol 2018; 14:1089-1099. [PMID: 30338718 DOI: 10.1080/1744666x.2018.1538790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Chronic hepatitis C virus (HCV) infection has been associated with myriad extrahepatic manifestations, often resulting from aberrant immune responses. Among the most common immune-mediated manifestations of HCV infection, mixed cryoglobulinemia is the best known extra-hepatic complication. Areas covered: Here we review less common extrahepatic manifestations of HCV infection, with ascertained or presumed immune pathogenesis and the role of the new all oral direct-acting antiviral agents. Rheumatologic, dermatologic, ophthalmologic, renal, pulmonary, hematologic, cardiovascular, and neuropsychiatric manifestations of HCV infection have been considered. Expert commentary: Pathogenesis of HCV-induced aberrant immune responses resulting in peculiar clinical manifestations is not restricted to a single mechanism. A sound approach would therefore consider implementation of an etiologic treatment, through use of antiviral medications, to stop upstream in the pathogenic process all the immune mechanisms leading to hepatic and extrahepatic abnormalities. With the recent introduction of interferon-free, direct antiviral agents, capable of warranting cure for nearly all HCV-infected patients subjected to therapy, both common and uncommon extrahepatic manifestations of chronic hepatitis C are expected to no longer constitute a matter of comorbidity in the course of HCV infection.
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Affiliation(s)
- Ciro Romano
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy
| | - Giovanna Cuomo
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy
| | - Roberta Ferrara
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy
| | - Andrea Del Mastro
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy.,b Department of Emergency and Admittance , Cardarelli Hospital , Naples , Italy
| | - Sergio Esposito
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy
| | - Ausilia Sellitto
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy.,c Department of Emergency and Admittance , "San Giuseppe Moscati" Hospital , Avellino , Italy
| | - Luigi Elio Adinolfi
- a Division of Internal Medicine, Department of Medical and Surgical Sciences , "Luigi Vanvitelli" University of Campania , Naples , Italy
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16
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Rademaker M, Agnew K, Anagnostou N, Andrews M, Armour K, Baker C, Foley P, Gebauer K, Gupta M, Marshman G, Rubel D, Sullivan J, Wong LC. Psoriasis and infection. A clinical practice narrative. Australas J Dermatol 2018; 60:91-98. [PMID: 30079566 DOI: 10.1111/ajd.12895] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/30/2018] [Indexed: 12/13/2022]
Abstract
The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on risk assessment for that patient, taking into account the infection being treated, the risk of recurrent infection, any interventions that can modify the risk and the need for psoriasis control. Live vaccines (e.g. MMR, varicella, zoster and yellow fever) are generally contraindicated in patients with psoriasis on immune-modulatory agents, but this depends on the degree of immune suppression and individual risk factors. Wound healing in psoriasis is normal. Treatment with infliximab, adalimumab, etanercept, methotrexate and ciclosporin can safely be continued through low-risk surgical procedures. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical School, Auckland University Medical School, Hamilton, New Zealand
| | - Karen Agnew
- Dermatology Department, Greenlane Clinical Centre & Starship Children's Hospital, Auckland, New Zealand
| | - Nicholas Anagnostou
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | | | - Christopher Baker
- Skin & Cancer Foundation Inc., Melbourne, Victoria, Australia.,St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Foley
- Skin & Cancer Foundation Inc., Melbourne, Victoria, Australia.,St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Gillian Marshman
- Flinders Medical Centre, Bedford Park, South Australia, Australia.,Flinders University Medical School, Adelaide, South Australia, Australia
| | - Diana Rubel
- Woden Dermatology, Phillip, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Sullivan
- Kingsway Dermatology, Miranda, New South Wales, Australia
| | - Li-Chuen Wong
- Dermatology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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17
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Damiani G, Franchi C, Pigatto P, Altomare A, Pacifico A, Petrou S, Leone S, Pace MC, Fiore M. Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents. World J Hepatol 2018; 10:329-336. [PMID: 29527268 PMCID: PMC5838451 DOI: 10.4254/wjh.v10.i2.329] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/18/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C (CHC) treated with new Direct-Acting Antiviral agents (DAAs) compared to pegylated interferon-2α plus ribavirin (P/R) therapy.
METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus (HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index (PASI) scores and the Dermatology Quality of Life Index (DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different bDMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response (SVR) were considered as outcomes of HCV therapy.
RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower (P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group (0/27) compared to 8 patients of the P/R group (8/32) needed a shift in biological treatment.
CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.
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Affiliation(s)
- Giovanni Damiani
- Study Center of Young Dermatologists Italian Network (YDIN), Gised, Bergamo, Italy and Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Chiara Franchi
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Paolo Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Andrea Altomare
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20126, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20126, Italy
| | - Alessia Pacifico
- San Gallicano Dermatological Institute, IRCCS, Rome 00144, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, St. George’s University Medical School, Grenada, West Indies
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
| | - Maria Caterina Pace
- Department of Anesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Marco Fiore
- Department of Anesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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18
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Fiore M, Leone S, Maraolo AE, Berti E, Damiani G. Liver Illness and Psoriatic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3140983. [PMID: 29546055 PMCID: PMC5818942 DOI: 10.1155/2018/3140983] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/30/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022]
Abstract
Psoriasis is a chronic inflammatory disease of the skin affecting approximately 2% of the world's population. Systemic treatments, including methotrexate and cyclosporin, are associated with potential hepatotoxicity, due to either direct liver damage or immunosuppression or both immunomediated and a direct liver injury; therefore, treatment of patients with psoriasis poses a therapeutic challenge. The aim of this minireview is to help clinicians in the management of psoriatic patients who develop signs of liver dysfunction. To find relevant articles, a comprehensive search was performed on PubMed, EMBASE, and Cochrane with appropriate combinations of the following keywords being considered: viral hepatitis, nonalcoholic fatty liver disease, psoriasis, hepatotoxicity, drug toxicity, cholestasis, and autoimmune liver diseases.
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Affiliation(s)
- Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sebastiano Leone
- Department of Medicine, Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Emilio Berti
- Department of Pathophysiology and Transplantation, Dermatology Unit, IRCCS Ca' Granda, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Pathophysiology and Transplantation, Dermatology Unit, IRCCS Ca' Granda, University of Milan, Milan, Italy
- Study Center of Young Dermatologists Italian Network (YDIN), Bergamo, Italy
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19
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Kikuchi S, Umezawa Y, Chihara M, Asahina A, Nakagawa H. Case of psoriatic patient who maintains long-term remission after anti-hepatitis C virus agents and ustekinumab treatment. J Dermatol 2018; 45:e59-e60. [PMID: 29388245 DOI: 10.1111/1346-8138.14229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sota Kikuchi
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mami Chihara
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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20
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Abstract
BACKGROUND HIV infection and inflammatory and autoimmune diseases (IADs) are both related to immune dysfunction. Epidemiological data on IAD in patients living with HIV (PLHIV) are scarce. The aim of this study was thus to estimate the prevalence of 26 IAD among PLHIV followed in a large French multicenter cohort in the combination antiretroviral therapy (cART) era (from January 2000 to July 2013), and to describe their occurrence according to cART onset, the immuno-virological status of patients and hepatitis C virus (HCV) and/or hepatitis B virus coinfection. METHOD AND RESULTS During the study period, 33 403 PLHIV were included in the Dat'AIDS cohort; 1381 patients with an IAD were identified. The most prevalent IADs were psoriasis, sarcoidosis, rheumatoid arthritis, ankylosing spondyloarthritis, Grave's disease, autoimmune hemolytic anemia, immune thrombocytopenia and chronic inflammatory bowel disease. In contrast, the prevalence of systemic lupus erythematosus and multiple sclerosis were low. Most patients (59%) developed IAD after HIV infection with a mean delay of 10.6 ± 6.4 years. Compared with the entire cohort, HCV coinfection was significantly more frequent in patients with psoriasis, Grave's disease and immune thrombocytopenia, and chronic hepatitis B in patients was more frequent in those with immune thrombocytopenia and autoimmune hemolytic anemia. Among patients developing IAD after the diagnosis of HIV infection, 572 (70%) were on antiretroviral therapy and 419 of them (73%) had undetectable HIV viral load. CONCLUSION Our study showed that some IAD are not rare among PLHIV and occur mostly in patients with immuno-virological control under cART. The higher frequency of HCV or hepatitis B virus coinfection for some IAD is also confirmed.
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21
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Prevalence of chronic hepatitis B and C in psoriasis patients: A cross-sectional study in a large US population. J Am Acad Dermatol 2017; 77:572-573. [DOI: 10.1016/j.jaad.2017.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
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22
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Noe MH, Grewal SK, Shin DB, Ogdie A, Takeshita J, Gelfand JM. Increased prevalence of HCV and hepatic decompensation in adults with psoriasis: a population-based study in the United Kingdom. J Eur Acad Dermatol Venereol 2017; 31:1674-1680. [PMID: 28485831 DOI: 10.1111/jdv.14310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/27/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The hepatitis C virus (HCV) is a major cause of global morbidity and mortality, with conflicting evidence regarding a possible association with psoriasis. OBJECTIVE To determine the prevalence of HCV in psoriasis patients, compared to controls, and to determine the incidence of hepatic decompensation in HCV+ psoriasis patients compared to HCV+ controls. METHODS Cross-sectional and cohort studies were conducted in The Health Improvement Network (THIN). RESULTS In fully adjusted models, a statistically significant increase in prevalence was seen in the adults with psoriasis (OR: 1.24, 95% CI 1.10-1.40). A "dose-response" of HCV prevalence with increasing psoriasis severity was not observed. HCV+ patients with psoriasis had a non-statistically significant increased incidence of hepatic decompensation compared to HCV+ individuals without psoriasis (aHR: 1.58, 95% CI: 0.90-2.77). The risk was highest and statistically significant, in those with moderate-to-severe psoriasis (aHR: 21.51, 95% CI: 7.58-61.03). CONCLUSIONS These results demonstrate a higher prevalence of HCV in adults with psoriasis and a higher rate of hepatic decompensation in HCV+ individuals with moderate-severe psoriasis.
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Affiliation(s)
- M H Noe
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - S K Grewal
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - D B Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - A Ogdie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - J M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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23
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Suh HY, Yoon YB, Ahn JY, Park MY, Youn JI. Association of Hepatitis B Virus Infection and Psoriasis. Ann Dermatol 2017; 29:822-824. [PMID: 29200785 PMCID: PMC5705378 DOI: 10.5021/ad.2017.29.6.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/28/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyun-Yi Suh
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Yong-Bum Yoon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ji-Young Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi-Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jai-Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
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Zohar A, Cohen AD, Bitterman H, Feldhamer I, Greenberg-Dotan S, Lavi I, Comanesther D, Batat E, Zisman D. Gastrointestinal comorbidities in patients with psoriatic arthritis. Clin Rheumatol 2016; 35:2679-2684. [PMID: 27530409 DOI: 10.1007/s10067-016-3374-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 01/14/2023]
Abstract
Comorbidities associated with psoriatic arthritis (PsA) include cardiovascular diseases, diabetes mellitus, and obesity. This study evaluated the association between PsA and common gastrointestinal (GI) diseases. A retrospective study was performed in Israel's largest health care provider database between 2002 and 2013. 3161 PsA patients were matched for age and sex with 31610 randomly selected patients. We searched these patients' records for the presence of peptic ulcer disease (PUD), reflux esophagitis, Crohn's disease, ulcerative colitis, irritable bowel syndrome (IBS) and celiac disease. T-test was used to compare continuous variables and a Chi-square test was used for categorical variables. Multivariate logistic regression models were used to assess the association between PsA and GI comorbidities. PsA was associated with Crohn's disease (OR 2.4, 95 %CI: 1.75-3.32, p < 0.0001), ulcerative colitis (OR 2.1, 95 %CI: 1.33-3.26, p = 0.001), reflux esophagitis (OR 1.6, 95 %CI: 1.44-1.78, p < 0.0001), PUD (OR 1.5, 95 %CI: 1.31-1.63, p < 0.0001) and IBS (OR 1.4, 95 %CI: 1.01-1.86, p = 0.045). After controlling for known risk factors, the association remained significant between PsA and Crohn's disease (OR 2.2, 95 %CI: 1.59-3.03, p < 0.0001), ulcerative colitis (OR 1.9, 95 %CI: 1.21-3.00, p = 0.005), reflux esophagitis (OR 1.5, 95 %CI: 1.31-1.63, p < 0.0001), and PUD (OR 1.3, 95 %CI: 1.12-1.47, p < 0.0001). No significant association was found between PsA and celiac disease. In the current study PsA was associated with gastrointestinal morbidities including Crohn's disease, ulcerative colitis, PUD and IBS. Physicians treating patients with PsA should be aware of these associations.
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Affiliation(s)
- Ariel Zohar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Arnon Dov Cohen
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Haim Bitterman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Ilan Feldhamer
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | | | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | | | - Erez Batat
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Devy Zisman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. .,Department of Rheumatology, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel.
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Bonifati C, Lora V, Graceffa D, Nosotti L. Management of psoriasis patients with hepatitis B or hepatitis C virus infection. World J Gastroenterol 2016; 22:6444-6455. [PMID: 27605880 PMCID: PMC5006156 DOI: 10.3748/wjg.v22.i28.6444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The systemic therapies available for the management of Psoriasis (PsO) patients who cannot be treated with more conservative options, such as topical agents and/or phototherapy, with the exception of acitretin, can worsen or reactivate a chronic infection. Therefore, before administering immunosuppressive therapies with either conventional disease-modifying drugs (cDMARDs) or biological ones (bDMARDs) it is mandatory to screen patients for some infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV). In particular, the patients eligible to receive an immunosuppressive drug must be screened for the following markers: antibody to hepatitis B core, antibody to hepatitis B surface antigen (anti-HBsAg), HBsAg, and antibody to HCV (anti-HCV). In case HBV or HCV infection is diagnosed, a close collaboration with a consultant hepatologist is needed before and during an immunosuppressive therapy. Concerning therapy with immunosuppressive drugs in PsO patients with HBV or HCV infection, data exist mainly for cyclosporine a (CyA) or bDMARDs (etanercept, adalimumab, infliximab, ustekinumab). The natural history of HBV and HCV infection differs significantly as well as the effect of immunosuppression on the aforementioned infectious diseases. As a rule, in the case of active HBV infection, systemic immunosuppressive antipsoriatic therapies must be deferred until the infection is controlled with an adequate antiviral treatment. Inactive carriers need to receive antiviral prophylaxis 2-4 wk before starting immunosuppressive therapy, to be continued after 6-12 mo from its suspension. Due to the risk of HBV reactivation, these patients should be monitored monthly for the first 3 mo and then every 3 mo for HBV DNA load together with transaminases levels. Concerning the patients who are occult HBV carriers, the risk of HBV reactivation is very low. Therefore, these patients generally do not need antiviral prophylaxis and the sera HBsAg and transaminases dosing can be monitored every 3 mo. Concerning PsO patients with chronic HCV infection their management with immunosuppressive drugs is less problematic as compared to those infected by HBV. In fact, HCV reactivation is an extremely rare event after administration of drugs such as CyA or tumor necrosis factor-α inhibitors. As a rule, these patients can be monitored measuring HCV RNA load, and ALT, aspartate transaminase, gamma-glutamyl-transferase, bilirubin, alkaline phosphatase, albumin and platelet every 3-6 mo. The present article provides an updated overview based on more recently reported data on monitoring and managing PsO patients who need systemic antipsoriatic treatment and have HBV or HCV infection as comorbidity.
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Jensen P, Egeberg A, Gislason G, Hansen PR, Thyssen JP, Skov L. Increased Risk of Autoimmune Hepatitis in Patients with Psoriasis: A Danish Nationwide Cohort Study. J Invest Dermatol 2016; 136:1515-1517. [DOI: 10.1016/j.jid.2016.02.812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
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Chun K, Afshar M, Audish D, Kabigting F, Paik A, Gallo R, Hata T. Hepatitis C may enhance key amplifiers of psoriasis. J Eur Acad Dermatol Venereol 2016; 31:672-678. [PMID: 27184185 DOI: 10.1111/jdv.13578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/27/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Multiple studies have noted an association between hepatitis C and psoriasis, but it is not known whether psoriasis is a result of treatment modalities for hepatitis C or a result of hepatitis C alone. OBJECTIVE To examine the relationship between psoriasis and hepatitis C by measuring the expression of cathelicidin, TLR9 and IFNγ in psoriatic lesional and non-lesional skin in HCV-positive and negative psoriatic patients. METHODS Two 2 mm punch biopsies of lesional and non-lesional skin in 10 patients who were HCV-negative psoriatics and seven HCV-positive psoriatics were used to measure cathelicidin, TLR9 and IFNγ mRNA expression by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR). RESULTS The mRNA levels of cathelicidin, TLR9 and IFNγ were significantly higher in both non-lesional and lesional skin of HCV-positive patients with psoriasis as compared to HCV-negative psoriatic patients. Additionally, the IFNγ level in lesional skin of HCV-positive psoriatic patients was higher than the IFNγ level seen in non-lesional skin of those same patients. CONCLUSION These findings suggest that HCV infection upregulates these inflammatory cytokines, possibly increasing susceptibility to developing psoriasis.
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Affiliation(s)
- K Chun
- Department of Dermatology, University of California, San Diego, CA, USA
| | - M Afshar
- Department of Dermatology, University of California, San Diego, CA, USA
| | - D Audish
- Department of Dermatology, University of California, San Diego, CA, USA
| | - F Kabigting
- Department of Dermatology, University of California, San Diego, CA, USA
| | - A Paik
- Department of Dermatology, University of California, San Diego, CA, USA
| | - R Gallo
- Department of Dermatology, University of California, San Diego, CA, USA
| | - T Hata
- Department of Dermatology, University of California, San Diego, CA, USA
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Serum levels of IL-12 and IL-23 in psoriatic patients with or without concomitant hepatitis C. JOURNAL OF THE EGYPTIAN WOMENʼS DERMATOLOGIC SOCIETY 2016. [DOI: 10.1097/01.ewx.0000481338.75599.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garcovich S, Garcovich M, Capizzi R, Gasbarrini A, Zocco MA. Cutaneous manifestations of hepatitis C in the era of new antiviral agents. World J Hepatol 2015; 7:2740-2748. [PMID: 26644817 PMCID: PMC4663393 DOI: 10.4254/wjh.v7.i27.2740] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/23/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
The association of chronic hepatitis C virus (HCV) infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature, with varying strength of epidemiological association. Skin diseases which are certainly related with chronic HCV infection due to a strong epidemiological and pathogenetic association are mixed cryoglobulinemia, lichen planus and porphyria cutanea tarda. Chronic pruritus and necrolytic acral erythema are conditions that may share a possible association with HCV infection, while several immune-mediated inflammatory skin conditions, such as psoriasis, chronic urticaria and vitiligo, have been only anecdotally reported in the setting of chronic HCV infection. Traditional interferon-based treatment regimens for HCV infection are associated with substantial toxicity and a high-risk of immune-related adverse events, while the advent of new direct-acting antivirals with sustained virological response and improved tolerability will open the door for all-oral, interferon-free regimens. In the new era of these direct acting antivirals there will be hopefully a renewed interest in extra-hepatic manifestations of HCV infection. The aim of the present paper is to review the main cutaneous HCV-related disorders - mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda and chronic pruritus - and to discuss the potential impact of new antiviral treatments on the course of these extra-hepatic manifestations of chronic HCV infection.
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López-Serrano P, Briongos EDLF, Alonso EC, Pérez-Calle JL, Rodríguez CF. Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy. World J Hepatol 2015; 7:539-547. [PMID: 25848477 PMCID: PMC4381176 DOI: 10.4254/wjh.v7.i3.539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/07/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Currently immunosuppressive and biological agents are used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus (HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to pre-emptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary.
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Zisman D, Bitterman H, Shalom G, Feldhamer I, Comanesther D, Batat E, Greenberg-Dotan S, Cohen S, Cohen AD. Psoriatic arthritis treatment and the risk of herpes zoster. Ann Rheum Dis 2014; 75:131-5. [PMID: 25261573 DOI: 10.1136/annrheumdis-2013-205148] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 09/12/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the association between traditional disease-modifying antirheumatic drugs (c-DMARD) or anti-TNF-α agents and herpes zoster (HZ) in patients with psoriatic arthritis (PsA). METHODS A retrospective cohort study was conducted in patients with PsA between 2002 and 2013. Patients were grouped as follows: no DMARDs (Group A); c-DMARDs (Group B); anti-TNF-α agents (Group C); anti-TNF-α agents in combination with c-DMARDs (Group D). Crude incidence rates (IR) were calculated as number of HZ episodes per 1000 patient-years. A Cox regression model was used to adjust for HZ risk factors (age, gender, steroid use, Charlson Comorbidity Index score, and previous treatment) in order to estimate their contribution to the risk of the first HZ event. RESULTS The study included 3128 patients, mean age 50.26±14.54 years; 46.2% male. During a period of 20 096 person-years 182 HZ events were observed. The crude IR (95% CI) of HZ in the study population was 9.06 per 1000 patient-years, and in Groups A-D 7.36 (5.41 to 9.79), 9.21 (7.5 to 11.21), 8.64 (4.84 to 14.26), 17.86 (10.91 to 27.58), respectively. In a multivariate analysis, age (HR 1.01, 95% CI 1.00 to 1.02), treatment with steroids (HR 1.08, 95% CI 1.04 to 1.13), and a combination of anti-TNF-α agents and c-DMARDs (HR 2.37, 95% CI 1.32 to 4.22) were significantly associated with HZ events. CONCLUSIONS In our database, the risk of HZ was significantly increased with age, treatment with steroids, and combination of anti-TNF-α agents and c-DMARDs, but not with c-DMARDs or anti-TNF-α therapy alone. Time to HZ event was shorter in patients treated with anti -TNF-α agents.
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Affiliation(s)
- D Zisman
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - H Bitterman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - G Shalom
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - I Feldhamer
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - D Comanesther
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - E Batat
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - S Greenberg-Dotan
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - S Cohen
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - A D Cohen
- Chief Physician's Office Central Headquarters, Clalit Health Services, Tel Aviv, Israel Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Taha EA, Mekky MA, Morsy H, Saleh MA, Nafeh HM, Ez-Aldin AM, Sayed SK. Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris. Arab J Gastroenterol 2014; 15:98-102. [PMID: 25174792 DOI: 10.1016/j.ajg.2014.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 04/04/2014] [Accepted: 08/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIM Concomitant hepatitis C virus (HCV) infection and psoriasis vulgaris (PV) are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients. PATIENTS AND METHODS Between December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index (PASI) score assessment, liver function tests, HCV-RNA-polymerase chain reaction (PCR) assays, and sonographic examination of the liver. For comparative purposes, another matched group (n=26) with psoriasis only (HCV-negative group) was enrolled as a control. RESULTS During the period of the study, 20 patients with concomitant PV and HCV infection (HCV-positive group; 50% males, mean age of 44.15±10.66 years) were recruited. The mean PASI score was 44.75±10.38 and clinical signs of liver dysfunction were observed in 40% (n=8), 100% had abnormal liver function tests (n=20), and 75% had sonographic findings of cirrhosis (n=15). The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control (p<0.001). Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase (ALT). CONCLUSION When HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process.
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Affiliation(s)
- Emad A Taha
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Mohamed A Mekky
- Department of Gastroenterology & Tropical Medicine, Assiut University, Assiut, Egypt.
| | - Hanan Morsy
- Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
| | - Medhat A Saleh
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Hanan M Nafeh
- Department of Gastroenterology & Tropical Medicine, Assiut University, Assiut, Egypt
| | - Azza M Ez-Aldin
- Department of Clinical Pathology, Assiut University, Assiut, Egypt
| | - Sohair K Sayed
- Department of Clinical Pathology, Assiut University, Assiut, Egypt
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Gabr SA, Berika MY, Alghadir AH. Apoptosis and clinical severity in patients with psoriasis and HCV infection. Indian J Dermatol 2014; 59:230-6. [PMID: 24891650 PMCID: PMC4037940 DOI: 10.4103/0019-5154.131377] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND It has been proposed that hepatitis C virus (HCV) antigens are involved in the pathogenesis of psoriasis and may contribute to severity of the disease. Increased expression of the apoptosis-regulating proteins p53 and tTG and decreased levels of bcl-2 in the keratinocytes of the skin of psoriatic patients have been reported. AIM This study aims to identify the serum levels of apoptosis-regulating proteins in patients with psoriasis and without HCV infection and to study the relation between clinical severity of psoriasis and the presence of HCV infection. MATERIALS AND METHODS Disease severity was assessed by psoriasis area severity index score (PASI) of 90 patients with psoriasis grouped as mild (n = 30), moderate (n = 30) and severe (n = 30); 20 healthy individuals were used as controls. All groups were subjected for complete history taking, clinical examination, and tests for liver function and HCV infection. The serum levels of apoptosis related proteins: p53, tTG and bcl-2 were estimated by enzyme linked immune sorbent assay (ELISA). RESULTS There was a statistically significant (P < 0.001) correlation between clinical severity of psoriasis and presence of HCV antibodies and HCV-mRNA. In addition, significantly (P < 0.001) raised serum p53 and tTG, and reduced bcl-2 were observed among HCV-positive patients as compared to HCV-negative patients and control patients. CONCLUSION These results conclude that clinical severity of psoriasis is affected by the presence of HCV antibodies and overexpression of apoptotic related proteins. In addition, altered serum levels of apoptosis-regulating proteins could be useful prognostic markers and therapeutic targets of psoriatic disease.
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Affiliation(s)
- Sami A Gabr
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt ; Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia
| | - Mohamed Y Berika
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt ; Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia ; Rehabilitation Science Department, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia ; Medical Experimental Research Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia ; Rehabilitation Science Department, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia
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Yeung H, Takeshita J, Mehta NN, Kimmel SE, Ogdie A, Margolis DJ, Shin DB, Attor R, Troxel AB, Gelfand JM. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol 2013; 149:1173-9. [PMID: 23925466 DOI: 10.1001/jamadermatol.2013.5015] [Citation(s) in RCA: 332] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity. OBJECTIVE To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis. DESIGN, SETTING, AND PARTICIPANTS Population-based cross-sectional study of patient data from United Kingdom-based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without psoriasis. MAIN OUTCOMES AND MEASURES Prevalence of major medical comorbidity included in the Charlson comorbidity index. RESULTS Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05). CONCLUSIONS AND RELEVANCE The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Imafuku S, Naito R, Nakayama J. Possible association of hepatitis C virus infection with late-onset psoriasis: A hospital-based observational study. J Dermatol 2013; 40:813-8. [DOI: 10.1111/1346-8138.12240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/05/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Shinichi Imafuku
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka; Japan
| | - Reiko Naito
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka; Japan
| | - Juichiro Nakayama
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka; Japan
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Afshar M, Martinez AD, Gallo RL, Hata TR. Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: a review and analysis of 36 cases. J Eur Acad Dermatol Venereol 2013; 27:771-8. [PMID: 22671985 PMCID: PMC3443510 DOI: 10.1111/j.1468-3083.2012.04582.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Interferon-alpha (IFN-α) therapy is used to treat hepatitis C infection. The exacerbation and occurrence of psoriasis in hepatitis C patients treated with IFN-α is increasingly recognized, but the distinct associated features, aetiology and management have not been reviewed. OBJECTIVE To review all published cases of hepatitis C patients who developed psoriasis while receiving IFN-α therapy. METHODS The review was conducted by searching the PubMed database using the keywords 'hepatitis C' AND 'psoriasis.' In addition, references to additional publications not indexed for PubMed were followed to obtain a complete record of published data. RESULTS We identified 32 publications describing 36 subjects who developed a psoriatic eruption while receiving IFN-α therapy for hepatitis C. Topical therapies were a commonly employed treatment modality, but led to resolution in only 30% of cases in which they were employed solely. Cessation of IFN-α therapy led to resolution in 93% of cases. Hundred per cent of those who developed psoriasis while on IFN-α therapy responded to systemic therapy and were able to continue the drug. CONCLUSION Further studies and analysis of IFN-α-induced lesions are necessary to clarify the role of IFN-α and the hepatitis C virus in the development of psoriatic lesions.
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Affiliation(s)
- M Afshar
- Division of Dermatology, Department of Medicine, University of California, San Diego, USA.
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Kanada KN, Schupp CW, Armstrong AW. Association between psoriasis and viral infections in the United States: focusing on hepatitis B, hepatitis C and human immunodeficiency virus. J Eur Acad Dermatol Venereol 2012; 27:1312-6. [PMID: 22564047 DOI: 10.1111/j.1468-3083.2012.04563.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND No published data in the U.S. population regarding an association between viral infections and psoriasis are currently available. Assessment of infection and immunosuppression risk is critical in managing psoriasis patients. OBJECTIVES To examine the association between psoriasis and viral infections including hepatitis B, hepatitis C and human immunodeficiency viral infections in the general U.S. population. METHODS Population data representative of the U.S. cohort were analysed from the National Health and Nutrition Examination Survey (NHANES), 2003-2006. Hepatitis B, hepatitis C, and human immunodeficiency antibodies status were ascertained from laboratory evaluations. Univariate and multivariate analyses were performed to assess the associations between psoriasis and these viral infections. RESULTS Among 6532 participants aged 20-59 years who provided responses to their psoriasis status, 162 patients reported having psoriasis. Based on multivariate regression analyses, psoriasis was not significantly associated with positive serology for hepatitis B core [odds ratio (OR), 0.83; 95% confidence interval (CI), 0.32-2.17; P = 0.7060], hepatitis B surface [OR, 7.89; CI, 0.52-119; P = 0.1355], hepatitis C [OR, 0.24; CI, 0.03-2.01; P = 0.1915], or human immunodeficiency virus [OR, 0.73; CI, 0.09-5.93; P = 0.7646] antibodies, after adjusting for age, gender, race and smoking status. CONCLUSIONS From the limited sample of the NHANES database on psoriasis and viral infections, psoriasis does not appear to be associated with an increased risk of hepatitis B, hepatitis C, or HIV infection in the U.S. population. Epidemiology of these viral infections in psoriasis needs to be continually studied and updated given their importance in management considerations.
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Affiliation(s)
- K N Kanada
- University of California San Diego School of Medicine, San Diego, CA, USA Department of Dermatology, University of California Davis Health System, Sacramento, CA, USA
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Brazzelli V, Carugno A, Alborghetti A, Cananzi R, Sangiovanni L, Barbarini G, De Silvestri A, Borroni RG. Hepatitis C infection in Italian psoriatic patients: prevalence and correlation with patient age and psoriasis severity. J Eur Acad Dermatol Venereol 2011; 26:1581-2. [PMID: 22142565 DOI: 10.1111/j.1468-3083.2011.04360.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang YW, Keller JJ, Lin HC. Medical comorbidity associated with psoriasis in adults: a population-based study. Br J Dermatol 2011; 165:1037-43. [PMID: 21711339 DOI: 10.1111/j.1365-2133.2011.10494.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most publications to date on comorbidities associated with psoriasis have focused on cardiovascular and metabolic diseases. Few comprehensive investigations of medical comorbidities in a cohort of patients with psoriasis appear in the literature. OBJECTIVES To examine the prevalence of comorbidities in adult patients with psoriasis, including a comparison of comorbid prevalence vs. that in controls without psoriasis, in a nationally representative dataset in Taiwan. METHODS There were 1685 adult patients with psoriasis in the study group and 5055 randomly selected subjects in the comparison group. We used conditional logistic regression analyses to examine the risk of 29 comorbidities for these two groups after adjusting for monthly income, geographical region of residence and the level of urbanization of each patient's community of residence. RESULTS After adjusting for several potential confounders, patients with psoriasis had higher odds of comorbid congestive heart failure [odds ratio (OR) 1·63], ischaemic heart disease (OR 1·51), renal failure (OR 1·45), uncomplicated diabetes (OR 1·37), liver diseases (OR 1·34), hepatitis B or C (OR 1·34), complicated diabetes (OR 1·32), hyperlipidaemia (OR 1·28), hypertension (OR 1·24) and peptic ulcer (OR 1·22) than did patients without psoriasis. However, patients with mild psoriasis had higher odds of comorbidity only with uncomplicated diabetes (OR 1·55), asthma (OR 1·30), liver diseases (OR 1·30) and peptic ulcer (OR 1·26) than patients without psoriasis. CONCLUSIONS We conclude that psoriasis is associated with a variety of medical comorbidities including cardiovascular diseases, metabolic diseases, renal failure, liver diseases, viral hepatitis B or C, asthma and peptic ulcers.
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Affiliation(s)
- Y-W Yang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
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Dreiher J, Kresch FS, Comaneshter D, Cohen AD. Risk of Herpes zoster in patients with psoriasis treated with biologic drugs. J Eur Acad Dermatol Venereol 2011; 26:1127-32. [PMID: 21923837 DOI: 10.1111/j.1468-3083.2011.04230.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Little is known about the risk of herpes zoster (HZ), among patients with psoriasis treated with biologic drugs. OBJECTIVE To determine the incidence of HZ in patients with psoriasis and the association between HZ and use of biologic drugs in these patients. METHODS The study was performed utilizing the medical database of Clalit Health Services in Israel. The incidence of HZ events was calculated among patients with psoriasis treated with phototherapy, traditional systemic medications and biologic drugs. Incidence rates of HZ events were calculated for each medication, as well as hazard ratios adjusted for age, sex and healthcare utilization burden. RESULTS Among 22,330 psoriasis patients (215,656 person-years), 1321 HZ cases were diagnosed. The crude incidence rates per 1000 person-years were 6.0 for UVB phototherapy (95% confidence interval (CI), 0-12.8), 10.1 for PUVΑ (1.3-19.0), 5.4 for acitretin (2.2-8.7), 17.0 for methotrexate (10.6-23.4), 13.9 for etanercept (0.3-27.4), 19.3 for infliximab (0-45.8) and 4.6 for controls (CI, 4.3-5.0). No cases of HZ were seen among patients treated with alefacept, efalizumab or adalimumab. In a multivariate analysis, age, female sex, healthcare utilization pattern and corticosteroid treatment were associated with the time to HZ infection. The association of HZ with infliximab approached statistical significance (Hazard ratio: 1.77, 95% CI: 0.92-3.43), but none of the other biologic drugs were significantly associated with the risk of HZ. CONCLUSION Among patients with psoriasis, treatment with some biologic drugs was associated with a higher incidence of HZ compared with controls, though the difference was not statistically significant.
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Affiliation(s)
- J Dreiher
- Siaal Research Center, Division of Health in the Community, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Tsai TF, Wang TS, Hung ST, Tsai PIC, Schenkel B, Zhang M, Tang CH. Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. J Dermatol Sci 2011; 63:40-6. [PMID: 21543188 DOI: 10.1016/j.jdermsci.2011.03.002] [Citation(s) in RCA: 214] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/17/2011] [Accepted: 03/02/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent findings in psoriasis research have shown that psoriasis is frequently associated with systemic comorbidities. OBJECTIVES This study aims to describe the epidemiology of psoriasis and the prevalence of comorbidities in patients with psoriasis in Taiwan. METHODS Patients who had at least one outpatient visit or admission with ICD-9-CM diagnosis code 696.0-1 in the Taiwan National Health Insurance (NHI) claims database during 2006 were identified as psoriasis cases. The cases were further classified into moderate to severe psoriasis (sPsO) for those who had previously received systemic therapy during the study period and mild psoriasis (mPsO) for those who had not. The cases were matched in a 1:4 ratio with controls from a sample cohort of 997,771 enrolees representative of the Taiwan population. Matching variables included age, gender and residential area. Prevalence of comorbidities was assessed using prevalence relative risk (RR) based upon a Cox proportional regression model. RESULTS 51,800 psoriasis cases were identified (prevalence=0.235%; mean age=46.4±18.6; male:female=1.6:1) and 17.5% of cases were sPsO type. Psoriasis was associated with a significantly increased prevalence ratio (RR; [95% confidence interval]) for hypertension (1.51; [1.47, 1.56]), diabetes (1.64; [1.58, 1.70]), hyperglyceridaemia (1.61; [1.54, 1.68]), heart disease (1.32; [1.26, 1.37]), hepatitis B viral infection (1.73; [1.47, 2.04]), hepatitis C viral infection (2.02; [1.67, 2.44]), rheumatoid arthritis (3.02; [2.68, 3.41]), systemic lupus erythematosus (6.16; [4.70, 8.09]), vitiligo (5.94; [3.79, 9.31]), pemphigoid (14.75; [5.00, 43.50]), pemphigus (41.81; [12.41, 140.90]), alopecia areata (4.71; [2.98, 7.45]), lip, oral cavity and pharynx cancer (1.49; [1.22, 1.80]), digestive organs and peritoneum cancer (1.57; [1.41, 1.74]), depression (1.50; [1.39, 1.61]), fatty liver (2.27; [1.90, 2.71]), chronic airways obstruction (1.47; [1.34, 1.61]), sleep disorder (3.89; [2.26, 6.71]), asthma (1.29; [1.18, 1.40]), and allergic rhinitis (1.25; [1.18, 1.33]). Conversely, psoriasis was not associated with an increased risk of Crohn's disease. CONCLUSIONS Psoriasis was associated with a significantly increased risk of comorbidities, especially for those patients with moderate to severe disease. These health associations should be taken into consideration when evaluating the burdens of psoriasis and designing effective treatment plans.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, College of Medicine, National Taiwan University, and National Taiwan University Hospital, Taipei, Taiwan
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