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The effect of etanercept on hepatic fibrosis risk in patients with non-alcoholic fatty liver disease, metabolic syndrome, and psoriasis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Patients with psoriasis show a greater prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome than the general population. Moreover, patients with NAFLD and psoriasis are at higher risk of severe liver fibrosis than their counterparts with NAFLD and without psoriasis. The link between these three pathological conditions is a chronic low-grade inflammatory status. In this study, we aimed to evaluate the effect of etanercept versus psoralen and UVA (PUVA) therapy on the hepatic fibrosis risk in patients with psoriasis, metabolic syndrome, and NAFLD (with NAFLD diagnosed by ultrasonography).

Methods

Eighty-nine patients with chronic moderate-to-severe plaque-type psoriasis, metabolic syndrome, and NAFLD received etanercept or PUVA treatment. The two groups of patients were compared for anthropometric variables (body mass index and waist/hip ratio), lipid profile, glucose homeostasis, inflammatory status, risk of hepatic fibrosis, and ultrasonographic aspect of the liver, both at baseline (time [T] 0) and after 24 weeks of treatment (T24).

Results

After 24 weeks of treatment, only in the group receiving etanercept, we detected significant reductions (p < 0.05) in the aspartate transaminase (AST)/alanine transaminase (ALT) ratio, C-reactive protein (CRP) serum levels, fasting insulin levels, and homeostasis model assessment (HOMA) index, and a significant increase in the Quantitative Insulin-Sensitivity Check Index (QUICKI) (p < 0.05).

Conclusions

In patients with psoriasis, metabolic syndrome, and NAFLD, the risk of the development of hepatic fibrosis seems to be directly correlated with insulin resistance. Etanercept could be more efficacious to reduce the risk of developing hepatic fibrosis than PUVA therapy, and this preventive effect could be related to its anti-inflammatory and glucose homeostatic properties. We note that a limitation of the study was that the diagnosis of NAFLD was conducted by ultrasonography.

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Abbreviations

PASI:

Psoriasis Area Severity Index

BSA:

Body surface area

DLQI:

Dermatology Life Quality Index

NAFLD:

Non-alcoholic fatty liver disease

HOMA:

Homeostasis model assessment

QUICKI:

Quantitative Insulin-Sensitivity Check Index

PUVA:

Psoralen and UVA (therapy)

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Acknowledgments

No funding source supported the work.

Conflict of interest

The authors declare that no organization sponsored our research.

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Authors and Affiliations

  1. Dermatological Clinic, Department of Clinical and Molecular Medicine, Polytechnic University of Marche Region, Ancona, Italy

    A. Campanati, G. Ganzetti, L. Rosa & A. Offidani

  2. Clinic of Gastroenterology, Department of Clinical and Molecular Medicine, Polytechnic Marche University, Ancona, Italy

    A. Di Sario, A. Damiani & A. Benedetti

  3. Polytechnic Marche University, Ancona, Italy

    L. Sandroni

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  1. A. Campanati
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Correspondence to G. Ganzetti.

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Campanati, A., Ganzetti, G., Sario, A.D. et al. The effect of etanercept on hepatic fibrosis risk in patients with non-alcoholic fatty liver disease, metabolic syndrome, and psoriasis. J Gastroenterol 48, 839–846 (2013). https://doi.org/10.1007/s00535-012-0678-9

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  • DOI: https://doi.org/10.1007/s00535-012-0678-9

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