Efalizumab treatment in a patient receiving peginterferon and ribavirin for hepatitis C
Tiffani K. Hamilton, MD
July 15, 2008
Question:
Do you think it's safe to treat somebody for psoriasis with efalizumab at the same time as they are being treated for hepatitis C with peginterferon and ribavirin for 48 weeks? I cared for a patient who was being treated for hepatitis C with peginterferon/ribavirin, plus etanercept for psoriasis. At 24 weeks, he developed a staph infection on a hand, which required debridement and resulted in the loss of use of two fingers. The staph infection also caused severe anemia, and the hepatitis C treatment had to be stopped. Answer:
There have been no studies on safety with the combination of hepatitis c therapy and efalizumab. That said, efalizumab tends to be the least immunosuppressive in my practice. I see a very low incidence of infection, so I would not be opposed to continuing efalizumab with the treatment for the hepatitis C. Again, there have been no trials regarding safety, so careful monitoring of the patient is needed and any infection must be aggressively treated. I do find efalizumab to have a much lower infection rate that the anti-tumor necrosis factor drugs.
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