Paradoxe Hautreaktionen unter Therapie mit TNF-α-Antagonisten

Cutaneous side effects of TNF-alpha inhibitors

Since the early 1990s, tumor necrosis factor alpha (TNF-alpha) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. By now, comprehensive safety data has been compiled. While adverse reactions do occur, they are - in relation to the frequent use of these agents - rare and usually not serious. Cutaneous side effects include local injection site reactions, infections, immune-mediated reactions, and neoplasms. The most common serious adverse events are of an infectious nature. Mycobacteria but also non-mycobacterial pathogens, such as viruses and fungi, may cause serious, even lethal, systemic infections. The present article is meant to review current knowledge with respect to cutaneous side effects of TNF-alpha inhibitors.

[Status quo and prospects for systemic therapy of atopic dermatitis. Biologics ante portas]

Currently the only approved drug available for the systemic therapy of atopic dermatitis is cyclosporine; however, based on current data from published studies, azathioprine, methotrexate, and mycophenolate mofetil or mycophenolic acid can be administered off-label. Some biologics on the market that have been approved for other indications (ustekinumab, rituximab, tocilizumab) have been successfully used in a few patients with atopic dermatitis. The world's first prospective controlled studies with the biologic human anti-IL4R antibody dupilumab for the indication "atopic dermatitis" were published in 2014. These motivated (1) to extend the studies to dupilumab and (2) to clinically test antagonization of other target molecules of TH2 polarized, atopic inflammation, e.g., IL-13, IL-31, IL-22, TSLP, and CRTH2. A number of clinical trials are currently recruiting in this area and will provide interesting new insights for future therapeutic approaches in atopic dermatitis.