Safety and efficacy of anti-tumor necrosis factors α in patients with psoriasis and chronic hepatitis C

Up to date, in literature, it is still debated the role of anti-tumor necrosis factors (TNF)-alpha treatments in hepatitis C virus (HCV) patients. TNF-alpha performs a lot of functions, it is an important pro-inflammatory cytokine and it is involved in the host's immunity. Since TNF-alpha is implicated in the apoptotic signaling pathway of hepatocytes infected by HCV, anti TNF-a therapy may increase the risk of viral replication or their reactivation. However the treatment of anti TNF-alpha could have a healthful role because TNF-alpha appears to be engaged in the pathogenesis of liver fibrosis, inducing apoptotic pathways. We describe the case of a patient with plaquetype psoriasis and concomitant chronic HCV, who was treated successfully with anti-TNF agents simultaneously to cyclosporine without sign of reactivation of HCV and increase of liver enzymes. Our personal experience shows that anti-TNF-alpha agents are not only effective but also safe. Furthermore the combination therapy of cyclosporine and anti-TNF-alpha appears to be well-tolerated and able to reduce the amount of liver enzymes as well as HCV-viral-load. However systematic, large-scale studies with long follow-ups will be needed to confirm our results, in association with close liver function monitoring.