Outcomes - HCV psoriatic patients using Pegylated Interferon plus Ribavirin compared to new Direct-Acting Antiviral agents

World J Hepatol. Feb 27, 2018; 10(2): 329-336
Published online Feb 27, 2018. doi: 10.4254/wjh.v10.i2.329

Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents
Giovanni Damiani, Chiara Franchi, Paolo Pigatto, Andrea Altomare, Alessia Pacifico, Stephen Petrou, Sebastiano Leone, Maria Caterina Pace, Marco Fiore

Core tip: Psoriasis is a chronic inflammatory disease affecting approximately the 2% of population in Europe and North America. The hepatitis C virus (HCV) infection affects approximately the 3% of the world population with an estimated prevalence of 5 million people in the United States. Up to 0.06% of people in the United States suffer from both psoriasis and HCV. Psoriatic patients with HCV are excluded by randomized controlled clinical trials. Therefore, no data is currently available concerning the concomitant administration of biological disease modifying drugs and the new Direct-Acting Antiviral agents (DAAs) medications approved for the treatment of HCV infection. The aim of this study is to evaluate the outcomes in biological treatment and quality of life of psoriatic patients with HCV infection treated with DAAs compared to the previous standard therapy of Pegylated Interferon plus Ribavirin.

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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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