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Huang A, Groer C, Lu R, Forrest ML, Griffin JD, Berkland CJ. Glatiramer Acetate Complexed with CpG as Intratumoral Immunotherapy in Combination with Anti-PD-1. Mol Pharm 2022; 19:4357-4369. [DOI: 10.1021/acs.molpharmaceut.2c00730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Aric Huang
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Chad Groer
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, United States
- HylaPharm, LLC, Lawrence, Kansas 66047, United States
| | - Ruolin Lu
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, United States
| | - M. Laird Forrest
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, United States
- HylaPharm, LLC, Lawrence, Kansas 66047, United States
| | | | - Cory J. Berkland
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, Kansas 66047, United States
- Bioengineering Program, The University of Kansas, Lawrence, Kansas 66045, United States
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States
- Kinimmune, Inc., Saint Louis, Missouri 63141, United States
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2
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Smith RJ, Khurana M, Rubin AI, Kublaoui B, Perman MJ, Murthy AS. Painful nodules on the abdomen of a teenage male. Pediatr Dermatol 2021; 38:e12-e13. [PMID: 33870568 DOI: 10.1111/pde.14430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Robert J Smith
- Department of Dermatology, Hospital, University of Pennsylvania, Philadelphia, PA, USA
| | - Michele Khurana
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital, University of Pennsylvania, Philadelphia, PA, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bassil Kublaoui
- Department of Pediatric Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marissa J Perman
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aditi S Murthy
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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3
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Mott SE, Peña ZG, Spain RI, White KP, Ehst BD. Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda-like changes following injection with glatiramer acetate. J Cutan Pathol 2016; 43:1056-1061. [DOI: 10.1111/cup.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 06/13/2016] [Accepted: 08/08/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Sarah E. Mott
- School of Medicine; Creighton University; Omaha NE USA
| | - Zachary G. Peña
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
| | - Rebecca I. Spain
- Department of Neurology; Oregon Health and Sciences University; Portland OR USA
| | - Kevin P. White
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
- Department of Dermatopathology; Oregon Health and Sciences University; Portland OR USA
| | - Benjamin D. Ehst
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
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Abstract
A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.
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Affiliation(s)
- Ana M Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain.
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain
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Stieger M, Schmid JP, Yawalkar N, Hunziker T. Extracorporeal Shock Wave Therapy for Injection Site Panniculitis in Multiple Sclerosis Patients. Dermatology 2014; 230:82-6. [DOI: 10.1159/000368351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022] Open
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Márquez-Rebollo C, Vergara-Carrasco L, Díaz-Navarro R, Rubio-Fernández D, Francoli-Martínez P, Sánchez-De la Rosa R. Benefit of endermology on indurations and panniculitis/lipoatrophy during relapsing-remitting multiple sclerosis long-term treatment with glatiramer acetate. Adv Ther 2014; 31:904-14. [PMID: 25047757 DOI: 10.1007/s12325-014-0137-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Use of endermology (Endermologie®), which consists of a deep mechanical massage, in patients with multiple sclerosis receiving glatiramer acetate suggested improvements in injection-site indurations and panniculitis/lipoatrophy in our previous pilot experience. We aimed to assess the effect of endermology in a larger population of patients with multiple sclerosis receiving glatiramer acetate in clinical practice. METHODS This was the extension phase of our pilot experience, carried out in patients with relapsing-remitting multiple sclerosis (RRMS) and indurations and/or panniculitis/lipoatrophy associated with long-term glatiramer acetate administration. Patients underwent endermology sessions twice per week, for 6 weeks, according to clinical practice. RESULTS Seventy evaluable patients were included (mean age, 42.7±9.3 years; female, 95.7%; mean multiple sclerosis duration, 9.2±8.6 years; mean glatiramer acetate duration, 46.7±29.9 months). Fifty (71.4%) patients showed indurations and 58 (82.9%) panniculitis/lipoatrophy. After 12 endermology sessions, the number of patients with indurations significantly decreased (71.4% vs. 28.6%; p<0.001), as did the number of their indurations (4.2±3.6 vs. 3.7±3.4; p<0.001). Although the number of patients with panniculitis/lipoatrophy did not significantly decrease, there was a significant reduction in the number of areas of panniculitis/lipoatrophy (4.3±2.6 vs. 3.9±2.2; p<0.05). Forty-nine (98.0%) patients with indurations and 57 (98.3%) patients with panniculitis/lipoatrophy felt satisfied/very satisfied with treatment and considered endermology useful/very useful. Endermology was well tolerated, as some pain was reported in eight (11.4%) patients, discomfort in three (4.3%) patients, and local blotch/swelling and transient bruise in one (1.4%) patient each. Endermology enabled glatiramer acetate tolerance to be enhanced in 42 (60.0%) patients. CONCLUSION This project represents the largest experience available supporting the benefit of endermology in the reduction/disappearance of indurations and improvement in panniculitis/lipoatrophy in patients with RRMS receiving long-term glatiramer acetate treatment. Moreover, these benefits also contributed to enhancing glatiramer acetate tolerance.
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Affiliation(s)
- Carmen Márquez-Rebollo
- Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120, El Palmar, Spain
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7
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Requena L, Cerroni L, Kutzner H. Histopathologic patterns associated with external agents. Dermatol Clin 2012; 30:731-48, vii. [PMID: 23021056 DOI: 10.1016/j.det.2012.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A large number of foreign substances may penetrate the skin for both voluntary and involuntary reasons. The voluntary group includes the particulate materials used in tattoos and cosmetic fillers, whereas the involuntary group is almost always caused by accidental inclusion of external substances secondary to cutaneous trauma. This article focuses on the histopathologic findings seen in cutaneous reactions to exogenous agents, with special emphasis on the microscopic morphology of the external particles in recognizing specifically the involved substance (something that is becoming increasingly important in the event of litigation).
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avenida Reyes Católicos 2, Madrid 28040, Spain.
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Rubio Fernández D, Rodríguez Del Canto C, Marcos Galán V, Falcón N, Edreira H, Sevane Fernández L, Francoli Martínez P, Sánchez-De la Rosa R. Contribution of endermology to improving indurations and panniculitis/lipoatrophy at glatiramer acetate injection site. Adv Ther 2012; 29:267-75. [PMID: 22382874 DOI: 10.1007/s12325-012-0005-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Endermology is a mechanical massage therapy that enables fat mobilization and body contouring. The authors' aim was to assess the effect of endermology on indurations and panniculitis/lipoatrophy associated with subcutaneous administration of glatiramer acetate in patients with multiple sclerosis (MS). METHODS This was a multicenter pilot experience carried out in patients with MS treated with glatiramer acetate who showed indurations and/ or panniculitis/lipoatrophy at the injection site. Patients underwent endermology and glatiramer acetate treatment according to clinical practice. The primary endpoint was the change in indurations and/or panniculitis/lipoatrophy after 12 endermology sessions. RESULTS Between April and July 2011, a total of 13 evaluable patients were included (mean age, 40.7±3.1 years; female, 100%; white, 100%; mean MS duration, 10.1±2.3 years; previous MS treatment, 46.2%; mean glatiramer acetate treatment duration, 27.3±9.5 months). Eleven patients (84.6%) showed local indurations (mean diameter, 3.4±0.5 cm; mean number, 9.0±1.0) and six patients (46.2%) areas of panniculitis/ lipoatrophy (mean number, 5.0±1.1). After 12 endermology sessions, patients with indurations reported having experienced a reduction in size (10 patients [90.9%]; mean diameter, 0.1±0.05 cm; P<0.001) and number of indurations (nine patients [81.8%]; mean number, 2.3±1.1; P<0.005). These indurations completely disappeared from arms, thighs, buttocks, and abdomen in six (75.0%), six (75.0%), two (50.0%), and three (42.9%) patients, respectively. Three of these patients (27.3%) recovered from all indurations. Although panniculitis/lipoatrophy did not completely disappear, all patients reported improvements. Most patients with indurations (63.6%) felt very satisfied and considered endermology very useful for reducing indurations. All patients with panniculitis/lipoatrophy were satisfied and considered to be endermology useful in improving it. In addition, endermology enabled glatiramer acetate tolerance to be improved in most patients (60.0%). CONCLUSION Endermology may contribute to improving indurations and panniculitis/ lipoatrophy at the site of subcutaneous injection of glatiramer acetate in patients with MS, enabling areas of injection to recover, and treatment tolerance to increase.
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Balak DMW, Hengstman GJD, Çakmak A, Thio HB. Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review. Mult Scler 2012; 18:1705-17. [PMID: 22371220 DOI: 10.1177/1352458512438239] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for multiple sclerosis (MS). DMTs can be associated with cutaneous adverse events, which may influence treatment adherence and patient quality of life. In this systematic review, we aimed to provide an overview of the clinical spectrum and the incidence of skin reactions associated with DMTs. A systematic literature search was performed up to May 2011 in Medline, Embase, and Cochrane databases without applying restrictions in study design, language, or publishing date. Eligible for inclusion were articles describing any skin reaction related to DMTs in MS patients. Selection of articles and data extraction were performed by two authors independently. One hundred and six articles were included, of which 41 (39%) were randomized controlled trials or cohort studies reporting incidences of mainly local injection-site reactions. A large number of patients had experienced some form of localized injection-site reaction: up to 90% for those using subcutaneous formulations and up to 33% for those using an intramuscular formulation. Sixty-five case-reports involving 106 MS patients described a wide spectrum of cutaneous adverse events, the most frequently reported being lipoatrophy, cutaneous necrosis and ulcers, and various immune-mediated inflammatory skin diseases. DMTs for MS are frequently associated with local injection-site reactions and a wide spectrum of generalized cutaneous adverse events, in particular, the subcutaneous formulations. Although some of the skin reactions may be severe and persistent, most of them are mild and do not require cessation of DMT.
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Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Ramot Y, Rosenstock M, Klinger E, Bursztyn D, Nyska A, Shinar DM. Comparative Long-Term Preclinical Safety Evaluation of Two Glatiramoid Compounds (Glatiramer Acetate, Copaxone®, and TV-5010, Protiramer) in Rats and Monkeys. Toxicol Pathol 2011; 40:40-54. [DOI: 10.1177/0192623311424169] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Glatiramer acetate (GA), the active ingredient in Copaxone®, is a complex mixture of polypeptides used for the treatment of relapsing remitting multiple sclerosis. Glatiramoids are related mixtures that may differ in some characteristics of the prototype molecule. Our aim is to describe the long-term toxicity studies with protiramer (TV-5010), a new glatiramoid, in comparison with similar studies conducted with GA. The toxicity of twice-weekly subcutaneous injections of protiramer to Sprague-Dawley rats (twenty-six weeks) and cynomolgus monkeys (fifty-two weeks) was compared with similar studies done with daily subcutaneous injections of GA. Daily treatment with GA was safe and well tolerated, without systemic effects or death. Protiramer administration was not as well tolerated as GA and led to dose- and time-related mortalities, probably mediated through severe injection-site lesions both in rats and in monkeys. Bridging fibrosis in the liver and severe progressive nephropathy were seen in rats. A dose-related increase in eosinophils was observed in monkeys. The protiramer toxicity studies show that minor variations in the manufacturing of glatiramoids may lead to significant toxic effects. It is therefore essential that the safety of any new glatiramoid be studied in long-term preclinical studies before exposing humans.
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Affiliation(s)
- Yuval Ramot
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ety Klinger
- Teva Pharmaceutical Industries, Ltd, Petach Tikva, Israel
| | - Dizza Bursztyn
- Teva Pharmaceutical Industries, Ltd, Petach Tikva, Israel
| | - Abraham Nyska
- Consultant in Toxicological Pathology, Timrat, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Endermology: A treatment for injection-induced lipoatrophy in multiple sclerosis patients treated with sub cutaneous glatiramer acetate. Clin Neurol Neurosurg 2011; 113:721-4. [DOI: 10.1016/j.clineuro.2011.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/22/2011] [Accepted: 07/16/2011] [Indexed: 11/20/2022]
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Martínez-Morán C, Espinosa-Lara P, Nájera L, Romero-Maté A, Córdoba S, Hernández-Núñez A, Borbujo J. Embolia Cutis Medicamentosa (Nicolau Syndrome) After Glatiramer Acetate Injection. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Embolia cutis medicamentosa (síndrome de Nicolau) tras inyección de acetato de glatirámero. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:742-4. [DOI: 10.1016/j.ad.2010.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/09/2010] [Accepted: 12/17/2010] [Indexed: 11/21/2022] Open
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Abstract
BACKGROUND This is an updated Cochrane review of the previous version published (Cochrane Database of Systematic Reviews 2004 , Issue 1 . Art. No.: CD004678. DOI: 10.1002/14651858.CD004678)Previous studies have shown that glatiramer acetate (Copaxone (R)), a synthetic amino acid polymer is effective in experimental allergic encephalomyelitis (EAE), and improve the outcome of patients with multiple sclerosis (MS). OBJECTIVES To verify the clinical efficacy of glatiramer acetate in the treatment of MS patients with relapsing remitting (RR) and progressive (P) course. SEARCH STRATEGY We searched the Cochrane MS Group Trials Register (26 March 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2009), MEDLINE (PubMed) (January 1966 to 26 March 2009), EMBASE (January 1988 to 26 March 2009) and hand searching of symposia reports (1990-2009). SELECTION CRITERIA All randomised controlled trials (RCTs) comparing glatiramer acetate and placebo in patients with definite MS, whatever the administration schedule and disease course, were eligible for this review. DATA COLLECTION AND ANALYSIS Both patients with RR and P MS were analysed. Study protocols were comparable across trials. No major flaws were found in methodological quality. However, efficacy of blinding should be balanced against side effects, including injection-site reactions. MAIN RESULTS Among 409 retrieved references, we identified 16 RCTs; six of them, published between 1987 and 2007, met the selection criteria and were included in this review. Five hundred and forty RR patients and 1049 PMS contributed to the analysis. In RR MS, a decrease in the mean EDSS score (-0.33 and -0.45), was found respectively at 2 years and 35 months without any significant effect on sustained disease progression. The reduction of mean number of relapse was evident at 1 year (-0.35 ) 2 years (-0.51 ) and 35 months (-0.64), but significant studies ' heterogeneity was found. The number of hospitalisations and steroid courses were significantly reduced. No benefit was shown in P MS patients. No major toxicity was found. The most common systemic adverse event was a transient and self-limiting patterned reaction of flushing, chest tightness, sweating, palpitations, anxiety. Local injection-site reactions were observed in up to a half of patients treated with glatiramer acetate, thus making a blind assessment of outcomes questionable. AUTHORS' CONCLUSIONS Glatiramer acetate did show a partial efficacy in RR MS in term of relapse -related clinical outcomes, without any significant effect on clinical progression of disease measured as sustained disability. The drug is not effective in progressive MS patients.
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Affiliation(s)
- Loredana La Mantia
- Department of Neuroscience, Fondazione I.R.C.C.S. - Istituto Neurologico C. Besta, Via Celoria, 11, Milano, Italy, 20133
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Nunes J, Marinho RT, Velosa J. A Post-cure Complication. Am J Med 2010; 123:223-4. [PMID: 20193828 DOI: 10.1016/j.amjmed.2009.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 12/07/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Joana Nunes
- Department of Gastroenterology and Hepatology, Hospital Santa Maria, Lisbon, Portugal.
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Kluger N, Thouvenot E, Camu W, Guillot B. Cutaneous adverse events related to glatiramer acetate injection (copolymer-1, Copaxone®). J Eur Acad Dermatol Venereol 2009; 23:1332-3. [DOI: 10.1111/j.1468-3083.2009.03165.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hashimoto S, Ball N, Tremlett H. Progressive lipoatrophy after cessation of glatiramer acetate injections: a case report. Mult Scler 2008; 15:521-2. [PMID: 19091880 DOI: 10.1177/1352458508100504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ball NJ, Cowan BJ, Moore GRW, Hashimoto SA. Lobular panniculitis at the site of glatiramer acetate injections for the treatment of relapsing-remitting multiple sclerosis. A report of two cases. J Cutan Pathol 2008; 35:407-10. [DOI: 10.1111/j.1600-0560.2007.00819.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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