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Fijałkowska A, Wojtania J, Woźniacka A, Robak E. Psoriasis and Lupus Erythematosus-Similarities and Differences between Two Autoimmune Diseases. J Clin Med 2024; 13:4361. [PMID: 39124628 PMCID: PMC11312967 DOI: 10.3390/jcm13154361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Systemic lupus erythematosus (SLE) and psoriasis (Ps) are two clinically distinct diseases with different pathogenesis. However, recent studies indicate some similarities in both clinical presentation and pathogenetic mechanisms. The coexistence of both entities is very uncommon and has not been fully elucidated. Thus, it remains a diagnostic and therapeutic challenge. In fact, drugs used in SLE can induce psoriatic lesions, whereas phototherapy effective in Ps is an important factor provoking skin lesions in patients with SLE. The aim of this work is to discuss in detail the common pathogenetic elements and the therapeutic options effective in both diseases.
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Affiliation(s)
| | | | | | - Ewa Robak
- Department of Dermatology and Venereology, Medical University of Lodz, Haller sq. 1, 90-647 Lodz, Poland; (A.F.); (J.W.); (A.W.)
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Kim W, Oh SJ, Kim HJ, Kim JH, Gil JY, Ku YS, Kim JH, Kim HA, Jung JY, Choi IA, Kim JH, Kim J, Han JM, Lee KE. Development of a Risk Prediction Model for Adverse Skin Events Associated with TNF-α Inhibitors in Rheumatoid Arthritis Patients. J Clin Med 2024; 13:4050. [PMID: 39064094 PMCID: PMC11278277 DOI: 10.3390/jcm13144050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily targeting joints, significantly impacting patients' quality of life. The introduction of tumor necrosis factor-alpha (TNF-α) inhibitors has markedly improved RA management by reducing inflammation. However, these medications are associated with adverse skin reactions, which can vary greatly among patients due to genetic differences. Objectives: This study aimed to identify risk factors associated with skin adverse events by TNF-α in RA patients. Methods: A cohort study was conducted, encompassing patients with RA who were prescribed TNF-α inhibitors. This study utilized machine learning algorithms to analyze genetic data and identify markers associated with skin-related adverse events. Various machine learning algorithms were employed to predict skin and subcutaneous tissue-related outcomes, leading to the development of a risk-scoring system. Multivariable logistic regression analysis identified independent risk factors for skin and subcutaneous tissue-related complications. Results: After adjusting for covariates, individuals with the TT genotype of rs12551103, A allele carriers of rs13265933, and C allele carriers of rs73210737 exhibited approximately 20-, 14-, and 10-fold higher incidences of skin adverse events, respectively, compared to those with the C allele, GG genotype, and TT genotype. The machine learning algorithms used for risk prediction showed excellent performance. The risk of skin adverse events among patients receiving TNF-α inhibitors varied based on the risk score: 0 points, 0.6%; 2 points, 3.6%; 3 points, 8.5%; 4 points, 18.9%; 5 points, 36.7%; 6 points, 59.2%; 8 points, 90.0%; 9 points, 95.7%; and 10 points, 98.2%. Conclusions: These findings, emerging from this preliminary study, lay the groundwork for personalized intervention strategies to prevent TNF-α inhibitor-associated skin adverse events. This approach has the potential to improve patient outcomes by minimizing the risk of adverse effects while optimizing therapeutic efficacy.
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Affiliation(s)
- Woorim Kim
- College of Pharmacy, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Soo-Jin Oh
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
| | - Hyun-Jeong Kim
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
| | - Jun-Hyeob Kim
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
| | - Jin-Yeon Gil
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
| | - Young-Sook Ku
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
- Department of Pharmacy, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Joo-Hee Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - In-Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Ji-Hyoun Kim
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea
| | - Ji-Min Han
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
| | - Kyung-Eun Lee
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea (J.-M.H.)
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Behrangi E, Moodi F, Jafarzadeh A, Goodarzi A. Paradoxical and bimodal immune-mediated dermatological side effects of TNF-α inhibitors: A comprehensive review. Skin Res Technol 2024; 30:e13718. [PMID: 38700458 PMCID: PMC11067872 DOI: 10.1111/srt.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Due to the increasing prevalence of immune-mediated diseases such as psoriasis, lichen planus, rheumatoid arthritis and inflammatory bowel disease, dermatologists have turned to new biologic drugs known as DMARDs (disease-modifying anti-rheumatic drugs) in recent years. AREAS COVERED In this study, we evaluate the immune-mediated dermatological side effects of DMARDS by reviewing and analyzing previous peer-reviewed research on the effects of TNF-α inhibitors in the treatment of skin diseases, as well as adverse effects of these drugs and some of the main causes of these effects. EXPERT OPINION DMARDs are very effective in improving control of the above diseases. TNF-α inhibitors are an important group of DMARDs that are widely used. The paradoxical adverse events (PAEs) associated with the use of TNF-α inhibitors are divided into three categories: true paradoxical, borderline paradoxical, and non-paradoxical. True PAEs include conditions for which TNF-α inhibitors are approved for treatment. Borderline PAEs are considered to occur with this class of drugs for which there is no definite approval but for which there is sufficient evidence. Although these events are rare, early recognition of the accused drug and appropriate decision-making may prevent progression of complications and irreversible side effects.
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Affiliation(s)
- Elham Behrangi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
| | - Farzan Moodi
- School of MedicineIran University of Medical SciencesTehranIran
| | - Alireza Jafarzadeh
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Azadeh Goodarzi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
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Azzazi Y, Obaid Y, Khaled M, El-Komy MHM. Rosacea, a rare cutaneous adverse effect of antitumor necrosis factor alpha medications: a case report and review of the literature. Int J Dermatol 2024; 63:124-126. [PMID: 37828794 DOI: 10.1111/ijd.16881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Yousra Azzazi
- Department of Dermatology, Faculty of Medicine, Kasr Alainy Hospital, Cairo University, Giza, Egypt
| | - Yasmine Obaid
- Department of Dermatology, Faculty of Medicine, Kasr Alainy Hospital, Cairo University, Giza, Egypt
| | - Manar Khaled
- Department of Dermatology, Faculty of Medicine, Kasr Alainy Hospital, Cairo University, Giza, Egypt
| | - Mohamed H M El-Komy
- Department of Dermatology, Faculty of Medicine, Kasr Alainy Hospital, Cairo University, Giza, Egypt
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Hazrati A, Mirsanei Z, Heidari N, Malekpour K, Rahmani-Kukia N, Abbasi A, Soudi S. The potential application of encapsulated exosomes: A new approach to increase exosomes therapeutic efficacy. Biomed Pharmacother 2023; 162:114615. [PMID: 37011484 DOI: 10.1016/j.biopha.2023.114615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cell therapy is one of the methods that have shown promising results in treating diseases in recent decades. However, the use of different types of cells comes with limitations. The application of immune cells in cell therapy can lead to cytokine storms and inappropriate responses to self-antigens. Also, the use of stem cells has the potential to create tumors. Also, cells may not migrate to the injury site after intravenous injection. Therefore, using exosomes from different cells as therapeutic candidates were proposed. Due to their small size and favorable characteristics, such as biocompatibility and immunocompatibility, the easy storage and isolation, exosomes have attracted much attention. They are used in treating many diseases, including cardiovascular diseases, orthopedic diseases, autoimmune diseases, and cancer. However, the results of various studies have shown that the therapeutic efficiency of exosomes (Exo) can be increased by loading different drugs and microRNAs inside them (encapsulated exosomes). Therefore, analyzing studies investigating encapsulated exosomes' therapeutic ability is critical. In this study, we have examined the studies related to the use of encapsulated exosomes in treating diseases such as cancer and infectious diseases and their use in regenerative medicine. Compared to intact exosomes, the results show that the application of encapsulated exosomes has a higher therapeutic ability. Therefore it is suggested to use this method depending on the treatment type to increase the treatment's efficiency.
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Lopetuso LR, Cuomo C, Mignini I, Gasbarrini A, Papa A. Focus on Anti-Tumour Necrosis Factor (TNF)-α-Related Autoimmune Diseases. Int J Mol Sci 2023; 24:ijms24098187. [PMID: 37175894 PMCID: PMC10179362 DOI: 10.3390/ijms24098187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Anti-tumour necrosis factor (TNF)-α agents have been increasingly used to treat patients affected by inflammatory bowel disease and dermatological and rheumatologic inflammatory disorders. However, the widening use of biologics is related to a new class of adverse events called paradoxical reactions. Its pathogenesis remains unclear, but it is suggested that cytokine remodulation in predisposed individuals can lead to the inflammatory process. Here, we dissect the clinical aspects and overall outcomes of autoimmune diseases caused by anti-TNF-α therapies.
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Affiliation(s)
- Loris Riccardo Lopetuso
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Claudia Cuomo
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
| | - Irene Mignini
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, School of Medicine, Catholic University, 00168 Rome, Italy
| | - Alfredo Papa
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, School of Medicine, Catholic University, 00168 Rome, Italy
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Parra RS, Chebli JMF, Chebli LA, Lima Junior SFD, Lins Neto MA, Medeiros TRD, Faria FM, Feitosa MR, Nigro CMC, Féres O. Leukocytoclastic Vasculitis Secondary to Anti-Tumor Necrosis Factor Therapy in Inflammatory Bowel Diseases: A Multicenter Retrospective Cohort Study. J Clin Med 2023; 12:jcm12093165. [PMID: 37176606 PMCID: PMC10179457 DOI: 10.3390/jcm12093165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Vasculitis is an uncommon complication of biologics used to treat inflammatory bowel disease (IBD). This study describes a case series of vasculitis induced by anti-tumor necrosis factor (TNF) therapy in IBD patients. METHODS Retrospective assessments were performed using the medical records of adult IBD patients who underwent outpatient clinical follow-ups between January 2010 and December 2019 in order to identify patients with vasculitis caused by anti-TNF therapy. RESULTS There were 2442 patients altogether. Of these, 862 (35%) took anti-TNF medication. Five patients (0.6% of the overall patients; n = 3 (60%) Crohn's disease; n = 2 (40%), ulcerative colitis) were identified as having leukocytoclastic vasculitis (LCV) due to anti-TNF therapy; these patients were white, female, and non-smokers. The mean age of LCV diagnosis was 32.2 years, and the mean IBD duration was 7.2 years. The mean time between the start of biologic therapy and LCV onset was 30.8 months. Most of the patients were using adalimumab (80%; n = 4). All the patients were in remission at the time of the LCV diagnosis, and the vasculitis affected the skin in all cases. Anti-TNF therapy was discontinued in the five abovementioned patients, and the response of LCV to the oral steroids was significantly positive. Remarkably, all five patients experienced complete remission from LCV within 4-12 weeks after starting prednisone therapy, and none of them had LCV recurrence in the follow-up period (a mean duration of 28 months). CONCLUSIONS LCV is an unusual complication of anti-TNF therapy in the IBD setting. In this context, clinicians should have a high degree of suspicion of LCV in patients who develop an unexplained cutaneous rash.
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Affiliation(s)
- Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Júlio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | - Liliana Andrade Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | | | - Manoel Alvaro Lins Neto
- Department of Gastrointestinal Surgery, Federal University of Alagoas-UFAL, Maceió 57051-090, Brazil
| | | | - Francesca Maia Faria
- Department of Pathology and Forensic Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Cintia Maura Caseiro Nigro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
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Schaefer L, Comfere N, Sokumbi O. Development of Cutaneous T-Cell Lymphoma Following Biologic Treatment: A Systematic Review. Am J Clin Dermatol 2023; 24:153-164. [PMID: 36627479 DOI: 10.1007/s40257-022-00749-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphoma following biologic therapy is extremely rare. OBJECTIVE The aim of this systematic review was to investigate the development of cutaneous T-cell lymphoma (CTCL) following treatment with a biologic agent. METHODS A systematic literature review was performed for patients who developed CTCL after exposure to biologic therapy. Works were limited to English language and excluded animal studies, guidelines, and protocols. Potentially eligible titles were identified using controlled vocabulary in tandem with key words. The search strategy was peer-reviewed prior to execution. RESULTS Twenty-eight total studies revealed sixty-two patients who developed CTCL following exposure to a biologic agent. Of these, 44% were Caucasian, and the median age at diagnosis was 56 years. Seventy-six percent of patients received biologic therapy for a primary inflammatory skin condition. Dupilumab was the most reported (42%) agent amongst the cohort. The median time from initiation of the biologic agent to diagnosis of CTCL in these cases was 4 months (range: 0-84). Mycosis fungoides (65%) and Sézary syndrome (10%) were the most common subtypes of CTCL diagnosed. Twenty-one (34%) patients were reported to be alive with disease, outcome was not reported in 21 patients (34%), ten patients (16%) were alive and in complete remission, eight patients (13%) died of disease and two patients (3%) died due to other causes. CONCLUSION While biologic agents may have a role in the development of CTCL, in order to definitively elucidate their role, more methodologically robust studies (such as those that utilize population databases) would need to occur.
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Affiliation(s)
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.
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Liu Y, He J, Jiang J, Wang Y, Liu T. Reactive Arthritis Triggered by Adalimumab and Leflunomide in a Patient with Ankylosing Spondylitis. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2601-2605. [DOI: 10.2147/ccid.s390918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
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Polilli E, Frattari A, Esposito JE, Angelini G, Di Risio A, Mazzotta E, Coladonato S, Di Iorio G, Parruti G, Tocco P. SOX-1 antibodies in a patient with Crohn's disease: a case report. BMC Neurol 2022; 22:404. [PMID: 36324062 PMCID: PMC9628059 DOI: 10.1186/s12883-022-02923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The anti-SOX-1 antibodies have been mainly associated with Lambert-Eaton Myasthenic Syndrome (LETMS) and Small-Cell Lung Cancer (SCLC). In this report, we describe the interesting case of a patient with serum anti-SOX-1 antibodies and Crohn's Disease (CD) with ensuing neurological symptoms. CASE PRESENTATION A Caucasian 67-year-old female was admitted to the Emergency Department with seizures, vertigo, emesis, nausea, postural instability and recurrent falls, over a period of 10 days. She had been affected by Crohn's Disease since 1991. A CT scan failed to detect any ischemic or haemorrhagic lesion. A brain MRI revealed signs of leukoencephalopathy. Western blot analysis of her serum revealed a high titre of the onconeural antibody anti-SOX1, consistent with a neurological, cerebellar type, paraneoplastic syndrome. In spite of multiple efforts to unmask a possible underlying malignancy, no neoplastic lesion cropped up during hospitalization. Her clinical conditions progressively deteriorated, up to respiratory failure; a few days later she died, due to ensuing septic shock and Multiple Organ Failure. CONCLUSIONS Our experience may usher and reveal a new role of anti-neural antibodies, so far reckoned an early indicator of associated malignancy, suggesting that neurological syndromes associated with such antibodies may complicate also chronic Gastrointestinal (GI) diseases. As of now, testing for anti-neuronal antibodies appeared unnecessary within the diagnostic assessment of gastroenterological disorders, which may lead to overlooking incident neurologic autoimmune diseases. Further exploration of such research hypothesis in clinical grounds appears intriguing.
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Affiliation(s)
- Ennio Polilli
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Via Fonte Romana, 8, 65124 Pescara PE, Pescara, Italy
| | - Antonella Frattari
- grid.461844.bIntensive Care Unit, Pescara General Hospital, Pescara, Italy
| | - Jessica Elisabetta Esposito
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Via Fonte Romana, 8, 65124 Pescara PE, Pescara, Italy
| | - Gilda Angelini
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Via Fonte Romana, 8, 65124 Pescara PE, Pescara, Italy
| | - Annalisa Di Risio
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Via Fonte Romana, 8, 65124 Pescara PE, Pescara, Italy
| | - Elena Mazzotta
- grid.461844.bInfectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Simona Coladonato
- grid.461844.bInfectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Giancarlo Di Iorio
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Via Fonte Romana, 8, 65124 Pescara PE, Pescara, Italy
| | - Giustino Parruti
- grid.461844.bInfectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Pierluigi Tocco
- grid.461844.bNeurology and Stroke Unit, Pescara General Hospital, Pescara, Italy
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Miyagawa F. Pathogenesis of Paradoxical Reactions Associated with Targeted Biologic Agents for Inflammatory Skin Diseases. Biomedicines 2022; 10:biomedicines10071485. [PMID: 35884790 PMCID: PMC9312477 DOI: 10.3390/biomedicines10071485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Targeted biologic agents have dramatically changed the therapeutic landscape for immune-mediated inflammatory diseases, particularly in rheumatology and dermatology. Their introduction has resulted in a paradigm shift, i.e., they produce significant clinical improvements in most patients with such diseases. Nevertheless, a variety of adverse reactions associated with these agents have been observed, including so-called paradoxical reactions (PRs), which are a new class of adverse events. PRs involve the de novo development or worsening of immune-mediated inflammatory disease during treatment with a targeted biologic agent that is commonly used to treat the idiopathic counterpart of the drug-induced reaction. In addition, the efficacy of biologic agents targeting individual cytokines and the existence of PRs to them have provided proof that cytokines are key drivers of various immune-mediated inflammatory diseases and helped researchers elucidate the molecular pathways underlying the pathophysiology of these diseases. Here, a comprehensive review of the targeted biologic agents used to treat immune-mediated inflammatory diseases, particularly psoriasis and atopic dermatitis, is provided, with a specific focus on biologic agents that inhibit cytokine signaling involving tumor necrosis factor-α, interleukin (IL)-12/23 (p40), IL-17A (and the IL-17 receptor [R]), IL-23 (p19), and the IL-4Rα, and their associated PRs. The characteristic clinical manifestations and potential immunological mechanisms of the PRs induced by these biologic agents are also reviewed.
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Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, Nara 634-8522, Japan
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Zhou X, Mubanga D, Chen Z, Bi X. Secondary Generalized Cutaneous Mucinosis Developed During Etanercept Treatment in a Patient with Psoriasis. Clin Cosmet Investig Dermatol 2022; 15:987-992. [PMID: 35669090 PMCID: PMC9166950 DOI: 10.2147/ccid.s368390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Cutaneous mucinosis is a rare disease that manifests as an excessive accumulation of mucin in the skin that forms waxy papules or plaques. We report a case of a 44-year-old male psoriatic patient who developed generalized cutaneous mucinosis after 11 months of biological treatment. The patient had a history of psoriasis for 20 years and had been treated with narrow-band UVB phototherapy, methotrexate, or acitretin intermittently. He was started on etanercept after he was diagnosed with psoriatic arthritis, and 11 months later, he complained of swelling in his extremities and myxoid cysts on his fingers. Etanercept was then discontinued due to loss of efficacy and widespread skin lesions. However, the lesions subsided spontaneously after 6 months without specific systemic treatment.
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Affiliation(s)
- Xin Zhou
- Department of Dermatology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - David Mubanga
- Department of Dermatology, Maina Soko Military Hospital, Lusaka, Zambia
| | - Zhuo Chen
- Department of Dermatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China
| | - Xinling Bi
- Department of Dermatology, Changhai Hospital, Naval Medical University, Shanghai, 200433, People’s Republic of China
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Eker H, Kaya İslamoğlu ZG, Demirbaş A. Vitiligo development in a patient with psoriasis vulgaris treated with ixekizumab. Dermatol Ther 2022; 35:e15314. [PMID: 35019197 DOI: 10.1111/dth.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/03/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hediye Eker
- Department of Dermatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | | | - Abdullah Demirbaş
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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14
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Šuler Baglama Š, Trčko K. Cutaneous adverse effects of biologic drugs in psoriasis: a literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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16
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Navarro R, Delgado-Jiménez Y, Guinea-Viniegra J, Llamas-Velasco M, Daudén E. Expression of microRNA-21 and TIMP-3 in paradoxical psoriasiform reactions during treatment with antitumor necrosis factor agents. J Cutan Pathol 2021; 49:116-122. [PMID: 34322902 DOI: 10.1111/cup.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Expression of microRNA-21 (miR-21) is increased in psoriasis, leading to reduced levels of epidermal tissue inhibitor of matrix metalloproteinase 3 (TIMP-3), a highly potent inhibitor of the tumor necrosis factor alpha (TNFα) sheddase TACE (TNFα-converting enzyme)/ADAM17. We described the profile of miR-21 and TIMP-3 in paradoxical psoriasiform reactions induced by anti-TNFα drugs and in a control group to elucidate the pathogenesis of this reactions. METHODS We performed an analytic, cross-sectional, prospective, experimental case-control study. We compared our findings with those of non-induced psoriasis. RESULTS We included 15 patients with a change of morphology (plaque to guttate psoriasis) and 10 patients with induced psoriasis (six palmoplantar pustulosis and four plaque psoriasis). Consecutive patients with different subtypes of non-induced, non-systemically treated psoriasis were included as a control group. We found that most cases with guttate psoriasis and with induced plaque psoriasis cases showed high expression of TIMP-3 expression and decreased or poorly increased levels of miR-21. The expression pattern was not homogeneous in the cases of induced palmoplantar pustulosis. These profiles differ from those of non-induced psoriasis. CONCLUSION We conclude that various pro-inflammatory cytokine profiles are involved in the pathogenesis of paradoxical psoriasiform reactions and non-induced psoriasis.
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Affiliation(s)
- Raquel Navarro
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Yolanda Delgado-Jiménez
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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17
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Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review. J Clin Med 2021; 10:jcm10051040. [PMID: 33802483 PMCID: PMC7959457 DOI: 10.3390/jcm10051040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
The biologic era has greatly improved the treatment of Crohn’s disease and ulcerative colitis. Biologics can however induce a wide variety of skin eruptions, especially those targeting the TNF-α and Th17 pathway. These include infusion reactions, eczema, psoriasis, lupus, alopecia areata, vitiligo, lichenoid reactions, granulomatous disorders, vasculitis, skin cancer, and cutaneous infections. It is important to recognize these conditions as treatment-induced adverse reactions and adapt the treatment strategy accordingly. Some conditions can be treated topically while others require cessation or switch of the biological therapy. TNF-α antagonists have the highest rate adverse skin eruptions followed by ustekinumab and anti-integrin receptor blockers. In this review, we provide an overview of the most common skin eruptions which can be encountered in clinical practice when treating IBD (Inflammatory bowel disease) patients and propose a therapeutic approach for each condition.
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Munera-Campos M, Vicente A, Rosende L, Rovira C. Lichen nitidus in a child receiving adalimumab for juvenile idiopathic arthritis. Indian J Dermatol Venereol Leprol 2021; 87:408-409. [PMID: 33666045 DOI: 10.25259/ijdvl_241_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Mónica Munera-Campos
- Department of Dermatology Sant Joan de Déu Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Asunción Vicente
- Department of Dermatology Sant Joan de Déu Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Laura Rosende
- Department of Dermatology Sant Joan de Déu Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Carlota Rovira
- Department of Pathology, Sant Joan de Déu Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain
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19
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Kishimoto K, Kawashima K, Fukunaga M, Kotani S, Sonoyama H, Oka A, Mishima Y, Oshima N, Ishimura N, Ishikawa N, Maruyama R, Ishihara S. Intermittent Purpura Development Associated with Leukocytoclastic Vasculitis Induced by Infliximab for Crohn's Disease. Intern Med 2021; 60:385-389. [PMID: 32863363 PMCID: PMC7925289 DOI: 10.2169/internalmedicine.5340-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Anti-tumor necrosis factor (TNF) α agents, widely used for the treatment of Crohn's disease (CD), can sometimes induce skin-associated adverse events, which mainly include psoriasis-like eruptions, eczema, and cutaneous infections. In contrast, purpura caused by vasculitis is rarely seen. We herein report a unique case of leukocytoclastic vasculitis induced by infliximab administered for CD in which intermittent purpura development was noted. Fluorescent immunostaining showed no immunoglobulin A deposition on the vessel walls. No purpura was initially seen after starting infliximab, but it appeared approximately 10 months later; however, administration did not have to be discontinued, and the condition was later resolved. The present findings provide important details regarding vasculitis induced by anti-tumor necrosis factor-α agent administration.
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Affiliation(s)
- Kenichi Kishimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Mai Fukunaga
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Satoshi Kotani
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | | | - Riruke Maruyama
- Department of Pathology, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
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Molinelli E, Sapigni C, Campanati A, Brisigotti V, Offidani A. Metabolic, pharmacokinetic, and toxicological issues of biologic therapies currently used in the treatment of hidradenitis suppurativa. Expert Opin Drug Metab Toxicol 2020; 16:1019-1037. [PMID: 32896186 DOI: 10.1080/17425255.2020.1810233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, relapsing, debilitating inflammatory dermatologic disease of the terminal hair follicles at intertriginous sites clinically characterized by painful inflammatory nodules, abscesses, draining sinus tracts, and dermal fibrosis. The management of hidradenitis suppurativa is a challenge and usually consists of both medical and surgical approaches, which must often be combined for best outcome. The introduction of biological therapies, specifically TNFα-inhibitors such as adalimumab, has profoundly changed the therapeutic armamentarium of the disease. AREAS COVERED The PubMed database was searched using combinations of the following keywords: hidradentis suppurativa, biologic therapy, TNF-α inhibitors, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects, pharmacodynamics, pharmacology, adverse events, pharmacokinetics, drug interaction. This article reviews and updates the chemistry, pharmacokinetics, mechanism of action, adverse effects, drug interactions of on-label and off-label use of TNF-α inhibitors in HS. EXPERT OPINION Biologic agents, particularly adalimumab, exhibit clinical efficacy in patients with hidradenitis suppurativa. Careful patient selection and close monitoring during treatment are mandatory to provide safe and effective use of the TNF-α inhibitor. Familiarity with biologic agents is crucial because these agents could become a consolidated treatment option in the clinician's therapeutic approaches.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Anna Campanati
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University , Ancona, Italy
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21
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Dermatomyositis-lupuslike syndrome overlap under treatment with etanercept for rheumatoid arthritis. JAAD Case Rep 2020; 6:758-760. [PMID: 32715073 PMCID: PMC7369515 DOI: 10.1016/j.jdcr.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Cossio ML, Genois A, Jantchou P, Hatami A, Deslandres C, McCuaig C. Skin Manifestations in Pediatric Patients Treated With a TNF-Alpha Inhibitor for Inflammatory Bowel Disease: A Retrospective Study [Formula: see text]. J Cutan Med Surg 2020; 24:333-339. [PMID: 32527153 DOI: 10.1177/1203475420917387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF) alpha inhibitors (anti-TNF) are effective in the treatment of inflammatory bowel disease (IBD) as well as psoriasis. Their increasing use has raised the identification of cutaneous side effects (CSEs). Evidence in children is limited. OBJECTIVES The objective of this study is to describe CSEs of anti-TNF treatment in a pediatric population with IBD. METHODS This is a retrospective single-center study of children with IBD under anti-TNF treatment between 2013 and 2016. A total of 40 patients with CSEs related to anti-TNF were referred to our pediatric dermatology clinic. A control group was randomly selected from patients receiving anti-TNF for IBD, who were referred to the dermatology clinic for other conditions unrelated to anti-TNF. RESULTS Of 343 patients with IBD, 40 (11.3%) presented CSEs potentially related to the treatment. No differences in sex, age, and underlying disease were found between those with and without CSEs. The most frequent CSEs were psoriasiform eruptions (41%) which were more exudative than usual, located especially in skin folds and on the scalp; skin infections (20%); and eczematous eruptions (10%). Only 5% of patients changed or discontinued the current anti-TNF because of CSEs. CONCLUSION This is one of the largest pediatric cohorts of IBD patients with CSEs. Psoriasiform eruptions were the most common CSEs, with predilection for skin folds and scalp, and frequent superimposed bacterial infection. Topical and/or systemic antibiotics were required in addition to topical corticosteroids in 25% of patients. The rate of discontinuation of anti-TNF therapy due to CSEs was low.
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Affiliation(s)
- María-Laura Cossio
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
- 28033Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Annie Genois
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Prévost Jantchou
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Afshin Hatami
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Colette Deslandres
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Catherine McCuaig
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
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Costa-Moreira P, Lopes S, Santos AL, Pedrosa AF, Andrade P, Portugal R, Macedo G. Leukocytoclastic Vasculitis Related to Ustekinumab in a Crohn's Disease Patient: First Case Report and Literature Review. J Crohns Colitis 2020; 14:274-276. [PMID: 31267125 DOI: 10.1093/ecco-jcc/jjz128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Leukocytoclastic vasculitis is a single-organ, skin-isolated small vessel vasculitis. It can be a side effect of many common drugs, including biological agents. Unlike with other drugs, leukocytoclastic vasculitis induced by biological agents may have a prolonged latency period. We report the first case of ustekinumab-induced leukocytoclastic vasculitis in a patient with inflammatory bowel disease.
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Affiliation(s)
- Pedro Costa-Moreira
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Ana Luísa Santos
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Portugal
| | - Ana Filipa Pedrosa
- Dermatology Department, Centro Hospitalar e Universitário São João, Porto Portugal
| | - Patrícia Andrade
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Portugal
| | - Raquel Portugal
- Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Portugal
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Obeid G, Do G, Kirby L, Hughes C, Sbidian E, Le Cleach L. Interventions for chronic palmoplantar pustulosis. Cochrane Database Syst Rev 2020; 1:CD011628. [PMID: 31958161 PMCID: PMC6984641 DOI: 10.1002/14651858.cd011628.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Palmoplantar pustulosis is a chronic inflammatory disease in which sterile, relapsing pustules appear on the palms and soles, possibly in conjunction with other symptoms. The previous Cochrane Review on this topic was published in 2006, before biological treatments were extensively used. OBJECTIVES To assess the effects of interventions for chronic palmoplantar pustulosis to induce and maintain complete remission. SEARCH METHODS We searched the following databases up to March 2019: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of the included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We considered RCTs including people with palmoplantar pustulosis or chronic palmoplantar pustular psoriasis assessing topical therapy, systemic therapy, combinations of topical or systemic therapies, or non-pharmacological therapies compared with placebo, no intervention, or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our outcomes included 'Proportion of participants cleared or almost cleared', 'Proportion of participants with adverse effects serious or severe enough to cause withdrawal', 'Proportion of participants with at least 50% improvement in disease severity', and 'Proportion of participants with adverse effects'. MAIN RESULTS We included 37 studies (1663 participants; mean age 50 years (range 34 to 63); 24% males). These studies reported condition severity differently. Around half of the included trials stated the setting (hospitals, community clinics, or both). More than half of the studies were at high risk of bias in at least one domain. Our included studies assessed mainly systemic treatments (retinoids, ciclosporin, biologics, etretinate + PUVA (combination of psoralens and long-wave ultraviolet radiation) therapy combined, and antibiotics), but also topical treatments (dermocorticoids, vitamin D) and phototherapy (PUVA, ultraviolet A1 (UVA1)). Other interventions were assessed by single studies. The most common comparator was placebo. All results presented in this abstract were assessed in the short term (mean treatment duration was 11 weeks (range 8 to 24 weeks)) and are based on participants with chronic palmoplantar pustulosis. All outcome time point measurements were taken from baseline and assessed at the end of treatment. Short-term and long-term outcomes were defined as measurement up to 24 weeks after randomisation and between 24 and 104 weeks after randomisation, respectively. One trial (188 participants) assessed the topical vitamin D derivative maxacalcitol versus placebo and found that maxacalcitol may be more effective than placebo in achieving clearance (risk ratio (RR) 7.83, 95% confidence interval (CI) 1.85 to 33.12; low-quality evidence), and the risk of adverse effects (such as mild local irritation, pruritus, and haematological or urinary test abnormalities) is probably similar in both groups (RR 0.87, 95% CI 0.64 to 1.19; moderate-quality evidence). Severity was not reported. Two trials (49 participants) assessed PUVA therapy versus placebo or no treatment, providing very low-quality evidence. Adverse effects were reported with oral PUVA (including nausea, ankle swelling, and non-purulent conjunctivitis) and with local PUVA (including blistering, erythema, and pruritus). With regard to the systemic retinoid alitretinoin, one trial (33 participants; moderate-quality evidence) showed that alitretinoin probably makes little or no difference in reducing severity when compared to placebo (RR 0.69, 95% CI 0.36 to 1.30). A similar number of adverse events were reported in both treatment groups, including headache, cheilitis, nausea, arthralgia, and nasopharyngitis (RR 0.84, 95% CI 0.61 to 1.17). Clearance was not reported. There may be little or no difference between etanercept and placebo in achieving clearance (RR 1.64, 95% CI 0.08 to 34.28; 1 study; 15 participants; low-quality evidence); however, the 95% CI was very wide, showing there may be a difference between groups. Severity was not measured. More patients treated with placebo may achieve reduced severity than those treated with ustekinumab, but the wide 95% CI indicates there might be little or no difference between groups and there might be greater effect with ustekinumab (RR 0.48, 95% CI 0.11 to 2.13; 1 study; 33 participants; low-quality evidence). Clearance was not reported. It is uncertain whether guselkumab increases clearance when compared to placebo (2 studies; 154 participants) because the quality of evidence is very low, but guselkumab probably better reduces disease severity (RR 2.88, 95% CI 1.24 to 6.69; 1 study; 49 participants; moderate-quality evidence). Secukinumab is probably superior to placebo in reducing severity (RR 1.55, 95% CI 1.02 to 2.35; 1 study; 157 participants; moderate-quality evidence), but our clearance outcome was not reported. None of these trials reported on occurrence of adverse effects. Only two of the studies discussed above reported adverse effects serious or severe enough to cause withdrawal. Guselkumab may cause more serious adverse events when compared to placebo, but there is uncertainty due to the very wide 95% CI showing there may be little or no difference and showing more events with placebo (RR 2.88, 95% CI 0.32 to 25.80; 1 study; 49 participants; low-quality evidence). Secukinumab probably causes more serious adverse events than placebo (RR 3.29, 95% CI 1.40 to 7.75; 1 study; 157 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS Evidence is lacking for major chronic palmoplantar pustulosis treatments such as superpotent corticosteroids, phototherapy, acitretin, methotrexate, and ciclosporin. Risk of bias and imprecision limit our confidence. Maxacalcitol may be more effective than placebo in achieving clearance in the short term (low-quality evidence), and the risk of adverse effects is probably similar (moderate-quality evidence). Oral alitretinoin is probably no more effective than placebo in reducing severity, with a similar risk of adverse effects (moderate-quality evidence). Regarding biological treatments, we are uncertain of the effect of etanercept on clearance and the effect of ustekinumab on severity (low-quality evidence). Secukinumab and guselkumab are probably superior to placebo in reducing severity (moderate-quality evidence). Adverse events not requiring withdrawal were not reported for these treatments. Reporting of serious adverse effects was incomplete: compared to placebo, secukinumab probably caused more participant withdrawals (moderate-quality evidence), but we are uncertain of the effect of guselkumab (low-quality evidence). Future trials should assess commonly used treatments using validated severity and quality of life scales.
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Affiliation(s)
- Grace Obeid
- Hôpital du Sacré CœurDepartment of DermatologyBeirutLebanon
| | - Giao Do
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
| | - Lisa Kirby
- Queen Elizabeth University Hospital (The Southern General Hospital)Department of Dermatology1345 Govan RoadGlasgowUKG51 4TF
| | - Carolyn Hughes
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Emilie Sbidian
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
- Université Paris Est Créteil (UPEC)Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) ‐ EA 7379CréteilFrance
| | - Laurence Le Cleach
- Hôpital Henri MondorDepartment of Dermatology51 avenue du Général de Lattre de TassignyCréteilFrance94010
- Université Paris Est Créteil (UPEC)Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) ‐ EA 7379CréteilFrance
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25
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Adverse Cutaneous Reactions of Common Biologic Medications for Rheumatic Diseases. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Fania L, Morelli M, Scarponi C, Mercurio L, Scopelliti F, Cattani C, Scaglione GL, Tonanzi T, Pilla MA, Pagnanelli G, Mazzanti C, Girolomoni G, Cavani A, Madonna S, Albanesi C. Paradoxical psoriasis induced by TNF-α blockade shows immunological features typical of the early phase of psoriasis development. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2019; 6:55-68. [PMID: 31577850 PMCID: PMC6966707 DOI: 10.1002/cjp2.147] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Immunomodulation with anti‐TNF‐α is highly effective in the treatment of various immune‐mediated inflammatory diseases, including hidradenitis suppurativa (HS). However, this may be responsible for unexpected paradoxical psoriasiform reactions. The pathogenic mechanisms underlying the induction of these events are not clear, even though the involvement of innate immune responses driven by plasmacytoid dendritic cells (pDC) has been described. In addition, the genetic predisposition to psoriasis of patients could be determinant. In this study, we investigated the immunological and genetic profiles of three HS patients without psoriasis who developed paradoxical psoriasiform reactions following anti‐TNF‐α therapy with adalimumab. We found that paradoxical psoriasiform skin reactions show immunological features common to the early phases of psoriasis development, characterized by cellular players of innate immunity, such as pDC, neutrophils, mast cells, macrophages, and monocytes. In addition, IFN‐β and IFN‐α2a, two type I IFNs typical of early psoriasis, were highly expressed in paradoxical skin reactions. Concomitantly, other innate immunity molecules, such as the catheledicin LL37 and lymphotoxin (LT)‐α and LT‐β were overproduced. Interestingly, these innate immunity molecules were abundantly expressed by keratinocytes, in addition to the inflammatory infiltrate. In contrast to classical psoriasis, psoriasiform lesions of HS patients showed a reduced number of IFN‐γ and TNF‐α‐releasing T lymphocytes. On the contrary, IL‐22 immunoreactivity was significantly augmented together with the IL‐36γ staining in leukocytes infiltrating the dermis. Finally, we found that all HS patients with paradoxical reactions carried allelic variants in genes predisposing to psoriasis. Among them, SNPs in ERAP1, NFKBIZ, and TNFAIP genes and in the HLA‐C genomic region were found.
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Affiliation(s)
- Luca Fania
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Martina Morelli
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy.,Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Claudia Scarponi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Laura Mercurio
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Fernanda Scopelliti
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Caterina Cattani
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Giovanni Luca Scaglione
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy.,Laboratory of Molecular Oncology, "Giovanni Paolo II" Foundation, Catholic University of Sacred Heart, Campobasso, Italy
| | - Tiziano Tonanzi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Maria Antonietta Pilla
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Gianluca Pagnanelli
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Cinzia Mazzanti
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Cavani
- Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, INMP, Rome, Italy
| | - Stefania Madonna
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
| | - Cristina Albanesi
- Laboratory of Experimental Immunology and 1st Dermatology Division, IDI-IRCCS, Rome, Italy
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Campanati A, Paolinelli M, Diotallevi F, Martina E, Molinelli E, Offidani A. Pharmacodynamics OF TNF α inhibitors for the treatment of psoriasis. Expert Opin Drug Metab Toxicol 2019; 15:913-925. [PMID: 31623470 DOI: 10.1080/17425255.2019.1681969] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The treatment of psoriasis with conventional topical therapies and disease-modifying anti-rheumatic drugs (DMARDs) is often linked to unsatisfactory outcomes and the risk of serious adverse events. Over the last decades, research advances in understanding the role of tumor necrosis factor alpha (TNF α) and other cytokines in the pathogenesis of psoriasis have driven the introduction of biologic agents targeting specific immune mediators in everyday clinical practice. TNF α inhibitors are a consolidated treatment option for patients with moderate-to-severe disease with remarkable efficacy and a reassuring safety profile.Areas covered: The PubMed database was searched using combinations of the following keywords: psoriasis, TNF α inhibitors, biologic therapy, pharmacodynamics, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects. The aim of this review is to describe the pharmacodynamic profile of anti-TNF α inhibitors, currently approved by the European Medicines Agency (EMA) for the treatment of psoriasis, focusing on related clinical implications, also in comparison to the new generation biological therapies targeting the interleukin 23/interleukin 17 axis.Expert opinion: Pharmacodynamics of TNF α inhibitors should be fully considered in planning patient's therapy strategies, especially in case of secondary failures, poor adherence to treatment, instable psoriasis, high risk of infection, pregnant or lactating women, metabolic comorbidities, coexistence of other immune-mediated inflammatory diseases.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Matteo Paolinelli
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Frederico Diotallevi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Emanuela Martina
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Elisa Molinelli
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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28
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Pirkle S, Bhattacharjee S, Reddy S, Shi LL, Lee MJ, Dalal S. Anti-TNF Use Prior to Bowel Resection Is Not Associated With 30 Day Postoperative Complications: A National Database Study. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AbstractBackgroundInflammatory bowel disease (IBD) patients are often counseled to pause anti-tumor necrosis factor (TNF) therapy before surgery. Here, we assessed the effects of preoperative anti-TNF treatment on bowel resection complications.MethodsA national database analysis was performed. IBD patients who underwent bowel resection were included. Patients using preoperative anti-TNF were stratified by treatment regimen. Complication rates were compared between these groups and a control group with no anti-TNF history.ResultsTwenty thousand and sixty-eight patients matched our criteria. We observed no significant differences between preoperative anti-TNF regimens and postoperative bowel resection complications.ConclusionsThese data suggest that anti-TNF therapy may safely be continued prior to bowel resection.
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Affiliation(s)
- Sean Pirkle
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Srikanth Reddy
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL
| | - Michael J Lee
- Department of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL
| | - Sushila Dalal
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL
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29
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cis-Khellactone Inhibited the Proinflammatory Macrophages via Promoting Autophagy to Ameliorate Imiquimod-Induced Psoriasis. J Invest Dermatol 2019; 139:1946-1956.e3. [PMID: 30878677 DOI: 10.1016/j.jid.2019.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023]
Abstract
Psoriasis is a chronic inflammatory skin disease with unresolved pathogenesis. Studies on the pathogenesis of psoriasis have been extensively carried out, but treatments are still not satisfactory. In this study, we found improvement after treatment with cis-khellactone, a small molecular natural product, in imiquimod-challenged C57BL/6 mice. cis-Khellactone clearly reduced the level of cytokines in psoriatic skin, including IL-23, TNF-α, IL-1β, and IL-6, while limiting the inhibition of IL-17A, which is produced by T helper type 17 cells. cis-Khellactone treatment specifically decreased dermal macrophage infiltration in psoriatic skin but not in neutrophils or T cells. Additionally, compared with the control group, cis-khellactone significantly decreased the activation of NF-κB p65 in these infiltrated macrophages. Further study showed that cis-khellactone suppressed proinflammatory phenotypic macrophages by promoting autophagy. Blocking autophagy by silencing Beclin1 or Atg7 abrogated the effect of cis-khellactone on macrophages. The autophagy-dependent improvement in psoriasis from cis-khellactone treatment was further manifested by its limited effects on skin lesions in chloroquine-treated mice. Moreover, cis-khellactone showed lower toxicity levels than methotrexate in macrophages and primary hepatocytes. Taken together, cis-khellactone selectively modulated macrophage function and phenotype by inducing autophagy to ameliorate imiquimod-induced psoriasis in mice. Our research provides an effective strategy for the treatment of psoriasis.
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30
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Hansel K, Bianchi L, Tramontana M, Balato A, Scala E, Brozzi J, Stingeni L. Immediate local and systemic hypersensitivity due to etanercept and adalimumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:726-727. [DOI: 10.1016/j.jaip.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/31/2018] [Accepted: 06/20/2018] [Indexed: 12/22/2022]
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31
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Chao J, Dewyer N, McKenna MJ. Spontaneous Resolution of Cholesteatoma in a Patient on Long-Term Infliximab. Ann Otol Rhinol Laryngol 2019; 128:365-368. [DOI: 10.1177/0003489418823790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To describe an observed case of spontaneous regression of cholesteatoma in a patient on chronic anti-tumor necrosis factor-alpha (TNF-a) therapy and inspire further research into the role of TNF-a in cholesteatoma. Methods: Clinical assessment of disease in a single-patient case report. Results: A 49-year-old woman suffered a severe case of Stevens-Johnson syndrome when she was 12 years old, leaving her with bilateral corneal opacification and tympanic membrane perforations with extensive cholesteatoma. For her corneal opacification, a corneal prosthesis was placed, which was complicated by a foreign body reaction necessitating long-term therapy with infliximab, a monoclonal antibody against TNF-a that is therapeutic in some chronic inflammatory diseases. She was otherwise healthy and took no other medications. While on infliximab, the patient had spontaneous and complete resolution of her cholesteatoma without any surgical intervention. Conclusions: This surprising case suggests that there may be a prominent role of TNF-a in cholesteatoma pathophysiology and that TNF-a may be an effective target for nonsurgical therapy.
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Affiliation(s)
- Janet Chao
- Yale University School of Medicine, New Haven, CT, USA
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32
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Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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33
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Chebli JMF, de Oliveira Moreira B, da Rocha Ribeiro TC. An Unusual Cause of Skin Rash in Crohn's Disease. Gastroenterology 2018; 155:618-620. [PMID: 29409941 DOI: 10.1053/j.gastro.2018.01.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Julio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Minas Gerais, Brazil
| | - Bárbara de Oliveira Moreira
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Minas Gerais, Brazil
| | - Tarsila Campanha da Rocha Ribeiro
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Minas Gerais, Brazil
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34
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Munera-Campos M, Ballesca F, Carrascosa JM. Paradoxical Reactions to Biologic Therapy in Psoriasis: A Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:791-800. [PMID: 29903464 DOI: 10.1016/j.ad.2018.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 03/20/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023] Open
Abstract
Biologic drugs, which are molecules designed to act on specific immune system targets, have been shown to be very effective in treating various dermatological, rheumatological, and systemic diseases. As a group, they have an acceptable safety profile, but their use has been associated with the onset of both systemic and organ-specific inflammatory conditions. True paradoxical reactions are immune-mediated disorders that would usually respond to the biologic agent that causes them. There is still debate about whether certain other adverse reactions can be said to be paradoxical. The hypotheses proposed to explain the pathogenesis of such reactions include an imbalance in cytokine production, with an overproduction of IFN-α and altered lymphocyte recruitment and migration (mediated in part by CXCR3), and the production of autoantibodies. Some biologic therapies favor granulomatous reactions. While most of the paradoxical reactions reported have been associated with the use of TNF-α inhibitors, cases associated with more recently introduced biologic therapies -such as ustekinumab, secukinumab, and ixekizumab- are increasingly common. The study of paradoxical adverse events not only favors better management of these reactions in patients receiving biologic therapy, but also improves our knowledge of the pathogenesis of chronic inflammatory diseases and helps to identify potential therapeutic targets.
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Affiliation(s)
- M Munera-Campos
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - F Ballesca
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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35
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Sehgal R, Stratman EJ, Cutlan JE. Biologic Agent-Associated Cutaneous Adverse Events: A Single Center Experience. Clin Med Res 2018; 16:41-46. [PMID: 29610119 PMCID: PMC6108513 DOI: 10.3121/cmr.2017.1364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/12/2017] [Accepted: 12/15/2017] [Indexed: 01/16/2023]
Abstract
Biologic agents are regarded as an effective treatment for a variety of autoimmune diseases. These drugs have an acceptable safety and tolerability profile, although an increasing number of autoimmune conditions have been reported with their use. Additionally, a variety of cutaneous diseases have been associated with their use. Here we report our experience of adverse cutaneous events with the use of biologic agents. An alternative explanation for patients presenting with adverse cutaneous events including drug interactions must be carefully investigated.
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Affiliation(s)
- Rahul Sehgal
- Mayo Clinic Health System, Department of Rheumatology, Eau Claire, WI 54702 USA
| | - Erik J Stratman
- Marshfield Clinic Health System, Department of Dermatology, Marshfield, WI 54449 USA
| | - Jonathan E Cutlan
- Marshfield Clinic Health System, Department of Pathology, Marshfield, WI 54449 USA
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36
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Carrascosa JM, Del-Alcazar E. New therapies versus first-generation biologic drugs in psoriasis: a review of adverse events and their management. Expert Rev Clin Immunol 2018; 14:259-273. [DOI: 10.1080/1744666x.2018.1454835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J. M. Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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37
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Stoffel E, Maier H, Riedl E, Brüggen MC, Reininger B, Schaschinger M, Bangert C, Guenova E, Stingl G, Brunner PM. Analysis of anti-tumour necrosis factor-induced skin lesions reveals strong T helper 1 activation with some distinct immunological characteristics. Br J Dermatol 2018; 178:1151-1162. [PMID: 29143979 DOI: 10.1111/bjd.16126] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasiform and eczematous eruptions are the most common dermatological adverse reactions linked to anti-tumour necrosis factor (TNF)-α therapy. Yet, a detailed characterization of their immune phenotype is lacking. OBJECTIVES To characterize anti-TNF-α-induced inflammatory skin lesions at a histopathological, cellular and molecular level, compared with psoriasis, eczema (atopic dermatitis) and healthy control skin. METHODS Histopathological evaluation, gene expression (quantitative real-time polymerase chain reaction) and computer-assisted immunohistological studies (TissueFAXS) were performed on 19 skin biopsies from patients with inflammatory bowel disease (n = 17) and rheumatoid arthritis (n = 2) with new-onset inflammatory skin lesions during anti-TNF-α-therapy. RESULTS Although most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathological architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established chemokine (C-C motif) ligand 27/inducible nitric oxide synthase classifier. Despite some differences in immune skewing depending on the specific histopathological reaction pattern, all anti-TNF-α-induced lesions showed strong interferon (IFN)-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive T helper 1 lymphocytes. CONCLUSIONS New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.
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Affiliation(s)
- E Stoffel
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - H Maier
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - E Riedl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - M-C Brüggen
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - B Reininger
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - M Schaschinger
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - C Bangert
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - E Guenova
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - G Stingl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - P M Brunner
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, U.S.A
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38
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Qu H, Yang W, Li J. Structural characterization of a polysaccharide from the flower buds of Tussilago farfara, and its effect on proliferation and apoptosis of A549 human non-small lung cancer cell line. Int J Biol Macromol 2018; 113:849-858. [PMID: 29505876 DOI: 10.1016/j.ijbiomac.2018.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 01/23/2023]
Abstract
In present study, we purified a polysaccharide, TFPB1, from the flower buds of Tussilago farfara using DEAE-cellulose 52 anion-exchange and Sephacryl S-300 HR gel filtration chromatography. TFPB1 was a homogeneous polysaccharide with a molecular weight of 37.8kDa and composed of rhamnose, galacturonic acid, glucose, galactose, and arabinose, in a ratio of 13:13:1:7:12. Methylation and NMR results demonstrated that TFPB1 contained a rhamnogalacturonan I backbone consisting of a repeat disaccharide unit →4)-α-D-GalAp-(1→2)-α-L-Rhap-(1→, substituted by various type II arabinogalactan branches including terminal galactose, (1→3)-β-D-galactan and (1→5)-α-L-arabinan, attached to the O-4 of (1→2)-α-L-Rhap. TFPB1 was found to inhibit cell proliferation of A549 cells and induce cell apoptosis in vitro. Furthermore, TFPB1 downregulated the phosphorylation of Akt, and upregulated caspase-3, Fas, FasL, and Bax expression, but downregulated Bcl-2 expression. Therefore, TFPB1 exhibited anti-proliferative and anti-apoptotic effect partly depending on the suppression of Akt signaling pathway. These findings provided us a potential chemotherapeutic strategy for the treatment of human non-small cell lung cancer.
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Affiliation(s)
- Honglan Qu
- Department of Hematology and Oncology, Inner Mongolia Forestry General Hospital, Yakeshi 022150, China
| | - Wei Yang
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Jie Li
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.
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39
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Han M, Sun P, Li Y, Wu G, Nie J. Structural characterization of a polysaccharide from Sargassum henslowianum, and its immunomodulatory effect on gastric cancer rat. Int J Biol Macromol 2018; 108:1120-1127. [PMID: 29274428 DOI: 10.1016/j.ijbiomac.2017.12.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/26/2017] [Accepted: 12/19/2017] [Indexed: 01/17/2023]
Abstract
A complicated sulfated fucoidan, SHPPB2, was purified from Sargassum henslowianum by DEAE-cellulose 52 and Sephacryl S-300 column chromatography. Via chemical and spectral method, SHPPB2 was found to contain mannose, glucuronic acid, galactose, xylose, and fucose, in a ratio of 17.4: 13.5: 10.5: 16.8: 41.8, as well as 21.4% of sulfate. The methylation analysis demonstrated terminal, 3-, 4-, 2, 3-, and 3, 4- linked fucose, 2-, 2, 3-, 2, 4-, and 2, 4, 6- linked mannose, terminal, 4-, 6-, 2, 4-, 3, 4-, and 3, 6- linked galactose, terminal and 4- linked xylose, and 4- linked glucuronic acid. In addition, the sulfate groups were substituted on the C-2, C-3 or C-4 of 3- and 4- linked fucose, on the C-4 or C-6 of 2- linked mannose, and on C-2 or C-3 of 4- and 6- linked galactose. With the treatment of SHPPB2 in the N-methyl-N'-nitro-nitrosoguanidine (MNNG) induced gastric cancer rats, it was observed with an increased body weight, and improved immune organ indices. Furthermore, SHPPB2 could significantly promote splenocyte proliferation induced by ConA or LPS in gastric cancer rats, and improve anti-inflammatory cytokines (IL-2, IL-4, and IL-10) secretion, but reduce pro-inflammatory cytokines (IL-6 and TNF-α). Taken together, it suggested that SHPPB2 could improve immune function in gastric cancer rats. Thus, it could be explored as a potential immuno-therapy for gastric cancer treatment.
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Affiliation(s)
- Mingyang Han
- Department of General Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China
| | - Peichun Sun
- Department of General Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China
| | - Yuanyuan Li
- Department of Department of Reproductive Center, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China
| | - Gang Wu
- Department of General Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China
| | - Jiewei Nie
- Department of General Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, 450000, China.
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40
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Mancusi A, Piccinelli S, Velardi A, Pierini A. The Effect of TNF-α on Regulatory T Cell Function in Graft-versus-Host Disease. Front Immunol 2018. [PMID: 29541073 PMCID: PMC5835761 DOI: 10.3389/fimmu.2018.00356] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
FoxP3+ regulatory T cells (Tregs) are a subset of CD4+ T cells that can suppress proliferation and effector functions of T cells, B cells, NK cells, and antigen-presenting cells. Treg deficiency causes dramatic immunologic disease in both animal models and humans. As they are capable to suppress the function and the proliferation of conventional CD4+ and CD8+ T cells, Treg-based cell therapies are under evaluation for the treatment of various autoimmune diseases and are currently employed to prevent graft-versus-host disease (GvHD) in clinical trials of hematopoietic stem cell transplantation. Even though tumor necrosis factor-α (TNF-α) is well known for its pro-inflammatory role, recent studies show that it promotes Treg activation and suppressive function. In the present review, we discuss the role of TNF-α in Treg function and the possible implications on the actual treatments for immune-mediated diseases, with a particular attention to GvHD.
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Affiliation(s)
- Antonella Mancusi
- Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, University of Perugia, Perugia, Italy
| | - Sara Piccinelli
- Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Velardi
- Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonio Pierini
- Hematology and Clinical Immunology and Bone Marrow Transplant Program, Department of Medicine, University of Perugia, Perugia, Italy
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41
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Peer FC, Miller A, Pavli P, Subramaniam K. Paradoxical psoriasiform reactions of anti-tumour necrosis factor therapy in inflammatory bowel disease patients. Intern Med J 2017; 47:1445-1448. [DOI: 10.1111/imj.13637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Faseeha C. Peer
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Andrew Miller
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- ACT Dermatology; Canberra Australian Capital Territory Australia
| | - Paul Pavli
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Gastroenterology and Hepatology Unit, The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Kavitha Subramaniam
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Gastroenterology and Hepatology Unit, The Canberra Hospital; Canberra Australian Capital Territory Australia
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42
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Clinical Signs, Pathophysiology and Management of Cutaneous Side Effects of Anti-Tumor Necrosis Factor Agents. Am J Clin Dermatol 2017; 18:771-787. [PMID: 28597181 DOI: 10.1007/s40257-017-0296-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Approximately one in four patients treated with anti-TNF agents (infliximab, etanercept, adalimumab, certolizumab, and golimumab) develops cutaneous adverse events, typically months to years after the initiation of treatment, with xerosis cutis, eczema (often psoriasiform), psoriasis, palmoplantar pustulosis, cutaneous infections, alopecia, and skin cancer being the most frequently encountered. The typical skin lesion of anti-tumor necrosis factor (TNF)-treated patients is orange-red psoriasiform eczema affecting the flexures, genitalia, scalp, or face, with high susceptibility to bacterial superinfection with Staphylococcus aureus. When adequate dermatological treatment is administered to patients with skin lesions receiving anti-TNF treatment, the discontinuation of anti-TNF agents is only rarely required. Smoking, female sex, and Crohn's disease are most frequently observed as risk factors for anti-TNF-induced cutaneous adverse events. The underlying pathophysiology is still poorly understood, but epidermal permeability barrier dysfunction, increased susceptibility to bacterial superinfection, and cytokines derived from T helper (Th) 1 (interferon-γ), Th17 cells (interleukin [IL]-17A and IL-22), plasmocytic dendritic cells (interferon-α), and keratinocytes (IL-36γ and IL-17C) appear to play a role. In this review, we describe the clinical characteristics, risk factors, pathophysiology, and management of cutaneous adverse events of patients treated with anti-TNF agents. In addition, we try to give some practical guidance on how to prevent and manage the skin changes in anti-TNF-treated patients, based on our own experience with dermatological care in a large cohort of inflammatory bowel disease patients receiving anti-TNF therapy.
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Skalkou A, Manoli SM, Sachinidis A, Ntouros V, Petidis K, Pagkopoulou E, Vakirlis E, Pyrpasopoulou A, Dimitroulas T. Pyoderma gangrenosum and pyogenic arthritis presenting as severe sepsis in a rheumatoid arthritis patient treated with golimumab. Rheumatol Int 2017; 38:161-167. [PMID: 29075910 DOI: 10.1007/s00296-017-3861-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/19/2017] [Indexed: 01/27/2023]
Abstract
Rheumatoid arthritis is a systemic autoimmune disease resulting in joint destruction and deformities, but also associated with extraarticular and systemic manifestations. The later devastating conditions, such as the development of rheumatoid vasculitis, are more frequently encountered in seropositive patients and their incidence has been attenuated after the introduction of biologic disease modifying drugs, such as anti-tumor necrosis factor alpha (TNFa) agents, which generally have considerably contributed to the better control and long-term outcomes of the disease. Interestingly, autoimmune syndromes may, rarely, present in patients without a positive history after the initiation of treatment. We present a rare case of a woman with seronegative rheumatoid arthritis who developed pyoderma gangrenosum whistle on treatment with golimumab, a fully humanized anti TNFa antibody. The recording of this as well as analogous paradoxical autoimmune syndromes in association with the individual patient characteristics will render treating physicians aware of potential adverse reactions and assist in the understanding of the cytokine driven pathophysiological mechanisms underlying these disorders.
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Affiliation(s)
- Anastasia Skalkou
- 2nd Propedeutic Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia-Magdalini Manoli
- 1st Department of Dermatology, Hospital for Skin and Venereal Diseases, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Sachinidis
- 2nd Propedeutic Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Ntouros
- 2nd Propedeutic Department of Surgery, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Petidis
- 2nd Propedeutic Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Pagkopoulou
- 4th Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Efstratios Vakirlis
- 1st Department of Dermatology, Hospital for Skin and Venereal Diseases, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Pyrpasopoulou
- 2nd Propedeutic Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
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Man G, Hu LZ, Elias PM, Man MQ. Therapeutic Benefits of Natural Ingredients for Atopic Dermatitis. Chin J Integr Med 2017; 24:308-314. [PMID: 28861804 DOI: 10.1007/s11655-017-2769-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Indexed: 01/04/2023]
Abstract
Although a variety of regimens are available for the treatment of atopic dermatitis (AD), severe adverse reactions and unpopular costs often limit their usage. In contrast, certain inexpensive, naturally-occurring ingredients are proven effective for AD with fewer side effects. The beneficial effects of these ingredients can be attributed to inhibition of cytokine and chemokine expression, IgE production, inflammatory cell infiltration, histamine release, and/or the enhancement of epidermal permeability barrier function. Since herbal medicines are widely available, inexpensive and generally safe, they could be valuable alternatives for the treatment of AD, particularly for those patients who are not suitable for the utilization of immune modulators. In this review, we summarize the therapeutic benefits of natural ingredients for the treatment of AD and the mechanisms of their actions.
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Affiliation(s)
- George Man
- Dermatology Services, Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA, 94121, USA
| | - Li-Zhi Hu
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Peter M Elias
- Dermatology Services, Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA, 94121, USA
| | - Mao-Qiang Man
- Dermatology Services, Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA, 94121, USA.
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Leukocytoclastic Vasculitis and Dermal Perivascular Hemophagocytosis Associated With Adalimumab Therapy for Rheumatoid Arthritis. Am J Dermatopathol 2017; 40:57-59. [PMID: 28719435 DOI: 10.1097/dad.0000000000000959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumor necrosis factor (TNF)-α inhibitors target TNF-α to effectively treat autoimmune inflammatory conditions, such as rheumatoid arthritis. However, many cases of cutaneous and systemic vasculitis related to TNF-α inhibitors have been reported in the literature. Here, the authors report the first case of a 61-year-old Japanese woman who developed leukocytoclastic vasculitis with cutaneous perivascular hemophagocytosis, which was related to elevated cytokines and immune complexes after initiating adalimumab for rheumatoid arthritis without evidence of hemophagocytic syndrome and rarely encountered in the skin. The patient was successfully treated by discontinuing adalimumab and initiating corticosteroid therapy, which should be considered as the treatment of choice. We believe that our case confirms and adds to the evidence pertaining to the involvement of TNF-α in dermal perivascular hemophagocytosis, a histologic finding rarely observed in the skin.
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Szczęch J, Samotij D, Werth VP, Reich A. Trigger factors of cutaneous lupus erythematosus: a review of current literature. Lupus 2017; 26:791-807. [PMID: 28173739 DOI: 10.1177/0961203317691369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is currently believed that autoimmune conditions are triggered and aggravated by a variety of environmental factors such as cigarette smoking, infections, ultraviolet light or chemicals, as well as certain medications and vaccines in genetically susceptible individuals. Recent scientific data have suggested a relevant role of these factors not only in systemic lupus erythematosus, but also in cutaneous lupus erythematosus (CLE). A variety of environmental factors have been proposed as initiators and exacerbators of this disease. In this review we focused on those with the most convincing evidence, emphasizing the role of drugs in CLE. Using a combined search strategy of the MEDLINE and CINAHL databases the following trigger factors and/or exacerbators of CLE have been identified and described: drugs, smoking, neoplasms, ultraviolet radiation and radiotherapy. In order to give a practical insight we emphasized the role of drugs from various groups and classes in CLE. We also aimed to present a short clinical profile of patients with lesions induced by various drug classes.
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Affiliation(s)
- J Szczęch
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - D Samotij
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - V P Werth
- 2 Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center and Department of Dermatology University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - A Reich
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Park SK, Hwang PH, Yun SK, Kim HU, Park J. Tumor Necrosis Factor Alpha Blocker-Induced Erythrodermic Sarcoidosis in with Juvenile Rheumatoid Arthritis: A Case Report and Review of the Literature. Ann Dermatol 2017; 29:74-78. [PMID: 28223750 PMCID: PMC5318531 DOI: 10.5021/ad.2017.29.1.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 01/23/2023] Open
Abstract
The development of cutaneous sarcoidosis as a paradoxical adverse event of tumor necrosis factor alpha (TNF-α) blockers has been reported in the literature; however, an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy has not yet been reported. Herein, we report the first case of an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy and review previous studies of cutaneous sarcoidosis. A 6-year-old Korean girl who had been suffering from juvenile rheumatoid arthritis presented with generalized erythematous skin eruption involving more than about 90% of her body surface area. After 14 months of etanercept treatment, the new erythematous skin eruption had developed and progressed into generalized erythroderma. Exclusion of suspected co-medication had been performed based on medication history. She had no other systemic symptoms, and ophthalmologic and neurologic examinations were normal. Histopathologic findings of the skin lesion revealed diffuse non-caseating granulomatous infiltrates composed of epithelioid histiocytes with sparse lymphocytes involving the entire dermis. Periodic-acid-Schiff and acid-fast stains were negative, and acid-fast bacilli was not detected by polymerase chain reaction of the skin biopsy. Based on clinicopathologic findings, she was diagnosed with etanercept-induced sarcoidal granuloma. After discontinuation of the suspected agent, the lesions spontaneously disappeared.
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Affiliation(s)
- Su-Kyung Park
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - Pyung-Han Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Seok-Kweon Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Han-Uk Kim
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Park
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Ceribelli A, De Santis M, Isailovic N, Gershwin ME, Selmi C. The Immune Response and the Pathogenesis of Idiopathic Inflammatory Myositis: a Critical Review. Clin Rev Allergy Immunol 2017; 52:58-70. [PMID: 26780034 DOI: 10.1007/s12016-016-8527-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The pathogenesis of idiopathic inflammatory myositis (IIMs, including polymyositis and dermatomyositis) remains largely enigmatic, despite advances in the study of the role played by innate immunity, adaptive immunity, genetic predisposition, and environmental factors in an orchestrated response. Several factors are involved in the inflammatory state that characterizes the different forms of IIMs which share features and mechanisms but are clearly different with respect to the involved sites and characteristics of the inflammation. Cellular and non-cellular mechanisms of both the immune and non-immune systems have been identified as key regulators of inflammation in polymyositis/dermatomyositis, particularly at different stages of disease, leading to the fibrotic state that characterizes the end stage. Among these, a special role is played by an interferon signature and complement cascade with different mechanisms in polymyositis and dermatomyositis; these differences can be identified also histologically in muscle biopsies. Numerous cellular components of the adaptive and innate immune response are present in the site of tissue inflammation, and the complexity of idiopathic inflammatory myositis is further supported by the involvement of non-immune mechanisms such as hypoxia and autophagy. The aim of this comprehensive review is to describe the major pathogenic mechanisms involved in the onset of idiopathic inflammatory myositis and to report on the major working hypothesis with therapeutic implications.
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Affiliation(s)
- Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
- BIOMETRA Department, University of Milan, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy.
- BIOMETRA Department, University of Milan, Milan, Italy.
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Protic M, Schoepfer A, Yawalkar N, Vavricka S, Seibold F. Development of psoriasis in IBD patients under TNF-antagonist therapy is associated neither with anti-TNF-antagonist antibodies nor trough levels. Scand J Gastroenterol 2016; 51:1482-1488. [PMID: 27534974 DOI: 10.1080/00365521.2016.1218541] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The cause of anti-TNF-induced psoriasis is still unknown. OBJECTIVE We aimed to evaluate if the appearance of psoriasis under anti-TNF therapy is associated with anti-TNF antibody levels and TNF-antagonist trough levels. METHODS In this case-control study we identified 23 patients (21 with Crohn's disease [CD], two with ulcerative colitis [UC]) who developed psoriasis under infliximab (IFX, n = 20), adalimumab (ADA, n = 2), and certolizumab pegol (CZP, n= 1) and compared them regarding the anti-TNF-antagonist antibody levels with 85 IBD patients (72 with CD, 13 with UC) on anti-TNF therapy without psoriasis. RESULTS Median disease duration was not different between the two groups (7 years in the group with psoriasis under TNF-antagonists vs. 10 years in the control group, p = 0.072). No patient from the psoriasis group had antibodies against TNF-antagonists compared to 10.6% in the control group (p = 0.103). No difference was found in IFX trough levels in the group of patients with psoriasis compared to the control group (2.6 μg/mL [IQR 0.9-5.5] vs. 3.4 μg/mL [IQR 1.4-8.1], p = 0.573). TNF-antagonist therapy could be continued in 91.3% of patients with TNF-antagonist related psoriasis and most patients responded to topical therapies. CONCLUSION Anti-TNF-induced psoriasis seems to be independent of anti-TNF antibodies and trough levels. Interruption of Anti-TNF therapy is rarely necessary.
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Affiliation(s)
- Marijana Protic
- a Department of Gastroenterology , University Hospital Zvezdara , Belgrade , Serbia
| | - Alain Schoepfer
- b Division of Gastroenterology and Hepatology , Center Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Nikhil Yawalkar
- c Department of Dermatology , University Hospital Bern , Bern , Switzerland
| | - Stephan Vavricka
- d Department of Gastroenterology and Hepatology , Stadtspital Triemli , Zürich , Switzerland
| | - Frank Seibold
- e Division of Gastroenterology and Hepatology , University Hospital Fribourg , Fribourg , Switzerland
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Cordero-Coma M, Calleja-Antolín S, Garzo-García I, Nuñez-Garnés AM, Álvarez-Castro C, Franco-Benito M, Ruiz de Morales JG. Adalimumab for Treatment of Noninfectious Uveitis: Immunogenicity and Clinical Relevance of Measuring Serum Drug Levels and Antidrug Antibodies. Ophthalmology 2016; 123:2618-2625. [PMID: 27692527 DOI: 10.1016/j.ophtha.2016.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the rate of immunogenicity induced by adalimumab and its relationship with drug serum levels and clinical responses in patients with noninfectious uveitis. DESIGN Prospective observational study. PARTICIPANTS Consecutive patients from 1 referral center who initiated treatment with adalimumab for active noninfectious uveitis resistant to conventional therapy. METHODS All patients received 40 mg adalimumab every other week. Patients were evaluated clinically and immunologically before and after 4, 8, and 24 weeks of treatment. MAIN OUTCOME MEASURES Clinical evaluation included assessment of changes in visual acuity, degree of inflammation in the anterior chamber and vitreous cavity, central macular thickness, and retinal angiographic leakage. Immunologic evaluation included assessment of serum trough adalimumab and antibodies against adalimumab (AAA) levels and class II HLA typing. RESULTS Twenty-five patients were enrolled. Overall, 18 of 25 patients (72%) showed a favorable clinical response to adalimumab therapy. Eleven patients (44%) achieved a complete response and 7 (28%) achieved a partial response. However, 7 of 25 patients (28%) were considered nonresponders. Median trough adalimumab serum levels were higher in responders than in nonresponders (P < 0.001). We observed AAA positivity (AAA+) at least 1 time point in 8 of 25 patients (32%), including 4 with transitory AAA and 4 with permanent AAA. In all patients with permanent AAA+, trough adalimumab levels became undetectable (P < 0.001). However, in patients who demonstrated transitory AAA+, no correlation was observed between AAA titers and adalimumab trough levels (P = 0.2).Concomitant immunosuppression did not show any protective effect on adalimumab immunogenicity in our cohort. An association between the presence of AAA+ and a worse uveitis outcome was observed only in patients with permanent AAA+, which correlated with undetectable adalimumab trough levels (P = 0.014). CONCLUSIONS Treatment of noninfectious uveitis with adalimumab is associated with high rates of favorable clinical response. Overall, adalimumab trough levels were higher in responder patients. Development of permanent AAA was associated with undetectable trough adalimumab levels and worse uveitis outcome. Immunogenicity was more common in patients in whom uveitis was associated with a systemic disease and was not influenced by concomitant immunosuppressors.
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Affiliation(s)
- Miguel Cordero-Coma
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain; Instituto de Biomedicina (IBIOMED), University of León, León, Spain
| | | | - Irene Garzo-García
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain
| | - Ana M Nuñez-Garnés
- Immunology Service and Uveitis Unit, University Hospital of León, León, Spain
| | | | - Manuel Franco-Benito
- Uveitis Unit, Department of Ophthalmology, University Hospital of León, León, Spain
| | - Jose G Ruiz de Morales
- Instituto de Biomedicina (IBIOMED), University of León, León, Spain; Immunology Service and Uveitis Unit, University Hospital of León, León, Spain.
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