Ustekinumab is a human monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23 and is approved for the treatment of moderate to severe psoriasis. Given its immunosuppressive effects, particularly of IL-12, there is concern for reactivation of chronic viral and mycobacterial infections. We report a case of a male with psoriasis successfully treated with ustekinumab without reactivation of his chronic hepatitis B virus (HBV) and latent tuberculosis infection (LTBI). Although the risks and benefits should be carefully assessed, ustekinumab is a therapeutic option for patients with psoriasis and chronic hepatitis B or latent TB, provided that careful consideration is given to hepatitis B and TB prophylaxis during therapy.
KruegerG., KooJ., LebwohlM., MenterA., SternR.S., RolstadT.The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol.2001; 137(3): 280–284.
2.
SchönM.P., BoehnckeW-HPsoriasis. N Engl J Med.2005; 352(18): 1899–1912.
3.
NickoloffB.J., StevensS.R.What have we learned in dermatology from the biologic therapies?J Am Acad Dermatol.2006; 54(3 Suppl 2): S143–151.
4.
SterryW., BarkerJ., BoehnckeW-HBiological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol.2004; 151 Suppl 69: 3–17.
5.
NijstenT., MargolisD.J., FeldmanS.R., RolstadT., SternR.S.Traditional systemic treatments have not fully met the needs of psoriasis patients: results from a national survey. J Am Acad Dermatol.2005; 52(3 Pt 1): 434–444.
6.
Van de KerkhofP.C.M.Consistent control of psoriasis by continuous long-term therapy: the promise of biological treatments. J Eur Acad Dermatol Venereol.2006; 20(6): 639–650.
7.
AlwawiE.A., KruligE., GordonK.B.Long-term efficacy of biologics in the treatment of psoriasis: what do we really know?Dermatol Ther.2009; 22(5): 431–440.
8.
PappK.A., DekovenJ., ParsonsL.Biologic therapy in psoriasis: perspectives on associated risks and patient management. J Cutan Med Surg.2012; 16(3): 153–168.
9.
MenterA., GottliebA., FeldmanS.R.Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol.2008; 58(5): 826–850.
10.
AbramsonA., MenterA., PerrilloR.Psoriasis, hepatitis B, and the tumor necrosis factor-alpha inhibitory agents: a review and recommendations for management. J Am Acad Dermatol.2012; 67(6): 1349–1361.
11.
ViganòM., DegasperiE., AghemoA., LamperticoP., ColomboM.Anti-TNF drugs in patients with hepatitis B or C virus infection: safety and clinical management. Expert Opin Biol Ther.2012; 12(2): 193–207.
12.
GordonK.B., PappK.A., LangleyR.G.Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (Part II of II): results from analyses of infections and malignancy from pooled phase II and III clinical trials. J Am Acad Dermatol.2012; 66(5): 742–751.
13.
PappK.A., GriffithsC.E.M., GordonK.Long-term safety of ustekinumab in patients with moderate-to-severe psoriasis: final results from five years of follow-up [published online ahead of print January 2 2013]. Br J Dermatol.2013. http://onlinelibrary.wiley.com/doi/10.1111/bjd.12214/pdf. Accessed February 6, 2013.
Pérez-AlvarezR., Díaz-LagaresC., García-HernándezF.Hepatitis B virus (HBV) reactivation in patients receiving tumor necrosis factor (TNF)-targeted therapy: analysis of 257 cases. Medicine (Baltimore).2011; 90(6): 359–371.
16.
LoombaR., RowleyA., WesleyR.Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy. Ann Intern Med.2008; 148(7): 519–528.
17.
LokA.S.F., WardJ.W., PerrilloR.P., McMahonB.J., LiangT.J.Reactivation of hepatitis B during immunosuppressive therapy: potentially fatal yet preventable. Ann Intern Med.2012; 156(10): 743–745.
18.
FotiadouC., LazaridouE., IoannidesD.Safety of anti-tumour necrosis factor-α agents in psoriasis patients who were chronic hepatitis B carriers: a retrospective report of seven patients and brief review of the literature. J Eur Acad Dermatol Venereol.2011; 25(4): 471–474.
19.
LeonardiC.L., KimballA.B., PappK.A.Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet.2008; 371(9625): 1665–1674.
20.
PappK.A., LangleyR.G., LebwohlM.Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet.2008; 371(9625): 1675–1684.
21.
GriffithsC.E.M., StroberB.E., Van de KerkhofP.Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med.2010; 362(2): 118–128.
22.
LebwohlM., LeonardiC., GriffithsC.E.M.Long-term safety experience of ustekinumab in patients with moderate-to-severe psoriasis (Part I of II): results from analyses of general safety parameters from pooled Phase 2 and 3 clinical trials. J Am Acad Dermatol.2012; 66(5): 731–741.
23.
HeD., YanG., WangY.Serum levels of interleukin-12 in various clinical states with hepatitis B virus infection. Cell Immunol.2012; 272(2): 162–165.
24.
WuJ-F, WuT-C, ChenC-HSerum levels of interleukin-10 and interleukin-12 predict early, spontaneous hepatitis B virus e antigen seroconversion. Gastroenterology.2010; 138(1): 165–172.e1–3.
25.
OpelD., EconomidiA., ChanD.Two Cases of Hepatitis B in Patients With Moderate to Severe Psoriasis With Ustekinumab. J Drugs Dermatol.2012; 11(12): 1498–1501.
26.
KoskinasJ., TampakiM., DoumbaP.P., RallisE.Hepatitis B virus reactivation during therapy with ustekinumab for psoriasis in an HBsAg negative anti-HBs positive patient. Br J Dermatol.2012.
27.
NavarroR., VilarrasaE., HerranzP.Safety and effectiveness of ustekinumab and anti-tumor necrosis factor therapy in patients with psoriasis and chronic viral hepatitis b or c. A retrospective, multicentre study in a clinical setting. Br J Dermatol.2012.
28.
Filipe-SantosO., BustamanteJ., ChapgierA.Inborn errors of IL-12/23- and IFN-α-mediated immunity: molecular, cellular, and clinical features. Semin Immunol.2006; 18(6): 347–361.
29.
TsaiT-F, ChiuH-Y, SongM., ChanD.A case of latent tuberculosis reactivation in a patient treated with ustekinumab without concomitant isoniazid chemoprophylaxis in the PEARL trial. Br J Dermatol.2012.
30.
TsaiT-F, HoV., SongM.The safety of ustekinumab treatment in patients with moderate-to-severe psoriasis and latent tuberculosis infection. Br J Dermatol.2012; 167(5): 1145–1152.
HorsburghC.R., RubinE.J.Clinical practice. Latent tuberculosis infection in the United States. N Engl J Med.2011; 364(15): 1441–1448.
33.
SterlingT.R., VillarinoM.E., BorisovA.S.Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med.2011; 365(23): 2155–2166.
34.
MastroianniC.M., LichtnerM., CittonR.Current trends in management of hepatitis B virus reactivation in the biologic therapy era. World J Gastroenterol.2011; 17(34): 3881–3887.
