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Lestari W, Vella V, Yasir T, Zulfikar T. Case Report: A successful case of toxic epidermal necrolysis treated with plasmapheresis therapy. F1000Res 2022; 11:995. [PMID: 37128216 PMCID: PMC10148083 DOI: 10.12688/f1000research.125050.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Toxic epidermal necrosis (TEN) is rare and can be life-threatening for patients. Appropriate management of TEN patients could give optimal results and prevent complications. One treatment modality for TEN is plasmapheresis, which is rarely available in most cases with severe TEN. Here we reported a successful treatment of severe TEN with plasmapheresis. A 40-year-old woman under tuberculosis therapy complained of shortness of breath that began four days prior to hospital admission and worsened ever since. The patient's skin was peeling with red spots and rashes all over the body for a week. During the examination, the patient was compos mentis, and the SCORTEN score was 2 with 12.1% risk of mortality rate. Dermatological examination of the face, trunk and extremities found extensive erosions, loose bullae filled with clear fluid, brown crusts, and generalized distribution with more than 30% epidermolysis. The patient was diagnosed with toxic epidermal necrolysis caused by antituberculosis therapy. We treated the patient by discontinuing the suspected drugs and administering the corticosteroids, but no improvement was observed. The patient underwent two cycle plasmaphereses with 5% albumin, resulting in 1.2 liter of plasma exchange. Re-epithelialization was observed after three days, and the patient was discharged on day 8. This case-report highlights the important role of plasmapheresis in treating the TEN patients. However, a study with larger sample sizes is warranted to validate the efficacy of plasmapheresis in TEN.
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Affiliation(s)
- Wahyu Lestari
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Vella Vella
- Department of Dermato-Venereology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Dermato-Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Yasir
- Department of Anesthesiology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Anesthesiology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
| | - Teuku Zulfikar
- Department of Pulmonology, Medical Faculty, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Pulmonology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 24415, Indonesia
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Wang Y, Wang F, Li H, Hao X, Shen G, Sun Y, Xia J. Toxic Epidermal Necrolysis Induced by Leflunomide in a Patient With Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S565-S567. [PMID: 30720701 DOI: 10.1097/rhu.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3
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Dammacco R, Guerriero S, Alessio G, Dammacco F. Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review. Int Ophthalmol 2021; 42:689-711. [PMID: 34802085 PMCID: PMC8882568 DOI: 10.1007/s10792-021-02058-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Abstract
Purpose To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the administration of antirheumatic drugs. Methods A systematic literature search was performed using the PubMed, MEDLINE, and EMBASE databases. In addition, a cohort of 489 RA patients who attended the Authors’ departments were examined. Results Keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and anterior uveitis were diagnosed in 29%, 6%, 5%, 2%, and 10%, respectively, of the mentioned cohort. Ocular ADRs to non-steroidal anti-inflammatory drugs are rarely reported and include subconjunctival hemorrhages and hemorrhagic retinopathy. In patients taking indomethacin, whorl-like corneal deposits and pigmentary retinopathy have been observed. Glucocorticoids are frequently responsible for posterior subcapsular cataracts and open-angle glaucoma. Methotrexate, the prototype of disease-modifying antirheumatic drugs (DMARDs), has been associated with the onset of ischemic optic neuropathy, retinal cotton-wool spots, and orbital non-Hodgkin’s lymphoma. Mild cystoid macular edema and punctate keratitis in patients treated with leflunomide have been occasionally reported. The most frequently occurring ADR of hydroxychloroquine is vortex keratopathy, which may progress to “bull’s eye” maculopathy. Patients taking tofacitinib, a synthetic DMARD, more frequently suffer herpes zoster virus (HZV) reactivation, including ophthalmic HZ. Tumor necrosis factor inhibitors have been associated with the paradoxical onset or recurrence of uveitis or sarcoidosis, as well as optic neuritis, demyelinating optic neuropathy, chiasmopathy, and oculomotor palsy. Recurrent episodes of PUK, multiple cotton-wool spots, and retinal hemorrhages have occasionally been reported in patients given tocilizumab, that may also be associated with HZV reactivation, possibly involving the eye. Finally, rituximab, an anti-CD20 monoclonal antibody, has rarely been associated with necrotizing scleritis, macular edema, and visual impairment. Conclusion The level of evidence for most of the drug reactions described herein is restricted to the “likely” or “possible” rather than to the “certain” category. However, the lack of biomarkers indicative of the potential risk of ocular ADRs hinders their prevention and emphasizes the need for an accurate risk vs. benefit assessment of these therapies for each patient.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Aly L, Hemmer B, Korn T. From Leflunomide to Teriflunomide: Drug Development and Immunosuppressive Oral Drugs in the Treatment of Multiple Sclerosis. Curr Neuropharmacol 2017; 15:874-891. [PMID: 27928949 PMCID: PMC5652031 DOI: 10.2174/1570159x14666161208151525] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/03/2016] [Accepted: 05/12/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Immunosuppressive drugs have been used in the treatment of multiple sclerosis (MS) for a long time. Today, orally available second generation immunosuppressive agents have been approved or are filed for licensing as MS therapeutics. Due to semi-selective targeting of cellular processes, these second-generation immunosuppressive compounds might rather be immunomodulatory. For example, Teriflunomide inhibits the de novo pyrimidine synthesis and thus only targets rapidly proliferating cells, including lymphocytes. It is used as first line disease modifying therapy (DMT) in relapsing-remitting MS (RRMS). METHODS Review of online content related to oral immunosuppressants in MS with an emphasis on Teriflunomide. RESULTS Teriflunomide and Cladribine are second-generation immunosuppressants that are efficient in the treatment of MS patients. For Teriflunomide, a daily dose of 14 mg reduces the annualized relapse rate (ARR) by more than 30% and disability progression by 30% compared to placebo. Cladribine reduces the ARR by about 50% compared to placebo but has not yet been licensed due to unresolved safety concerns. We also discuss the significance of older immunosuppressive compounds including Azathioprine, Mycophenolate mofetile, and Cyclophosphamide in current MS therapy. CONCLUSION Teriflunomide has shown a favorable safety and efficacy profile in RRMS and is a therapeutic option for a distinct group of adult patients with RRMS.
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Affiliation(s)
- Lilian Aly
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675 Munich, Germany,
- Department of Experimental Neuroimmunology, Technische Universität München, Ismaningerstraße 22, 81675 Munich, Germany,
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675 Munich, Germany,
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675 Munich, Germany,
- Department of Experimental Neuroimmunology, Technische Universität München, Ismaningerstraße 22, 81675 Munich, Germany,
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Qu C, Lu Y, Liu W. Severe Bone Marrow Suppression Accompanying Pulmonary Infection and Hemorrhage of the Digestive Tract Associated with Leflunomide and Low-dose Methotrexate Combination Therapy. J Pharmacol Pharmacother 2017; 8:35-37. [PMID: 28405135 PMCID: PMC5370328 DOI: 10.4103/jpp.jpp_93_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A 60-year-old male patient developed hyperpyrexia, cough, expectoration with blood-stained sputum, mouth ulcers, and suppurative tonsillitis after receiving 35 days of combination treatment with leflunomide (LEF) and low-dose methotrexate (MTX) for active rheumatoid arthritis. On admission, routine blood tests showed severe thrombocytopenia, agranulocytosis, and decreased hemoglobin concentration compared with the relatively normal results of 1 month previously during the first hospitalization. Chest radiography revealed inflammation in both lungs, and a fecal occult blood test was positive. Given this presentation, severe bone marrow suppression accompanying pulmonary infection and hemorrhage of the digestive tract associated with LEF and MTX combination therapy was diagnosed. After 28 days of symptomatic treatment, the patient's complications subsided gradually. This case highlighted that bone marrow suppression associated with MTX and LEF combination therapy could be very serious, even at a normal dose or especially at the beginning of treatment. MTX and LEF combination therapy should be used with caution or be limited in those with a history of pulmonary disease, hemorrhage of the digestive tract, or other relevant diseases.
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Affiliation(s)
- Caihong Qu
- Department of Clinical Pharmacy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Lu
- Department of Internal Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Weimin Liu
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Dai C, Lu FN, Jin N, Yang B, Gao C, Zhao B, Fu JZ, Hong SF, Liang HT, Chen LH, Chen ZS, Chen J, Qi ZQ. Recombinant IL-33 prolongs leflunomide-mediated graft survival by reducing IFN-γ and expanding CD4(+)Foxp3(+) T cells in concordant heart transplantation. J Transl Med 2016; 96:820-9. [PMID: 27295346 DOI: 10.1038/labinvest.2016.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/13/2016] [Accepted: 03/29/2016] [Indexed: 11/09/2022] Open
Abstract
Interleukin (IL)-33 is a novel IL-1 family member, and its administration has been associated with promotion of T helper type-2 (Th2) cell activity and cytokines, particularly IL-4 and IL-5 in vivo. Recently, IL-33 was shown to increase CD4(+)Foxp3(+) regulatory T cells (Tregs) and to suppress levels of the Th1-type cytokine IFN-γ in allogeneic heart transplantation in mice. Therefore, we hypothesized that IL-33 and leflunomide (Lef) could prolong graft survival in the concordant mouse-to-rat heart transplantation model. In this model, xenografts undergo acute humoral xenograft rejection (AHXR) typically on day 3 or cell-mediated rejection approximately on day 7 if AHXR is inhibited by Lef treatment. Recipients were treated with Lef (n=6), IL-33 (n=6), IL-33 combined with Lef (n=6), or left untreated (n=6) for survival studies. Heart grafts were monitored until they stopped beating. Mouse heterotopic grafts were performed, and recipients were sacrificed on days 2 and 7 for histological and flow cytometric analyses. The combination of IL-33 and Lef significantly prolonged the grafts from 17.3±2.3 to 2.8±0.4 days, compared to untreated controls. IL-33 administration with Lef, while facilitating Th2-associated cytokines (IL-4 on day 2 but not day 7), also decreased IFN-γ on day 2 and day 7, compared with Lef treatment only. Furthermore, IL-33 with Lef administration caused an expansion of suppressive CD4(+)Foxp3(+) Tregs in rats. The IL-33 and Lef combination therapy resulted in significantly prolonged graft survival, associated with markedly decreased Th1 cells and increased IL-10 levels. In addition, the combination therapy significantly decreased the percentage of CD-45(+) B cells on days 2 and 7, compared with monotherapy. These findings reveal a new immunoregulatory property of IL-33. Specifically, it facilitates regulatory cells, particularly functional CD4(+)Foxp3(+) Tregs that underlie IL-33-mediated cardiac xenograft survival. Moreover, it can decrease Th1 cells and cytokine expression of Th1 T cells in xenograft recipients, for example IFN-γ.
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Affiliation(s)
- Chen Dai
- Institute of Organ Transplantation, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation of the Ministry of Education, Wuhan, Hubei, PR China.,Key Laboratory of Organ Transplantation of the Ministry of Health, Wuhan, Hubei, PR China
| | - Fang-Na Lu
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Ning Jin
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation of the Ministry of Education, Wuhan, Hubei, PR China.,Key Laboratory of Organ Transplantation of the Ministry of Health, Wuhan, Hubei, PR China
| | - Chang Gao
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Bin Zhao
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Jia-Zhao Fu
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Shi-Fu Hong
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Han-Ting Liang
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Li-Hong Chen
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Zhi-Shui Chen
- Institute of Organ Transplantation, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation of the Ministry of Education, Wuhan, Hubei, PR China.,Key Laboratory of Organ Transplantation of the Ministry of Health, Wuhan, Hubei, PR China
| | - Jie Chen
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
| | - Zhong-Quan Qi
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen, Fujian, PR China
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Gerschenfeld G, Servy A, Valeyrie-Allanore L, de Prost N, Cecchini J. Fatal toxic epidermal necrolysis in a patient on teriflunomide treatment for relapsing multiple sclerosis. Mult Scler 2015. [PMID: 26199352 DOI: 10.1177/1352458515596601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of toxic epidermal necrolysis in a 46-year-old woman on teriflunomide treatment. Such a severe adverse cutaneous drug reaction with this new therapy for relapsing forms of multiple sclerosis should be early recognized in order to ensure the rapid withdrawal of the drug.
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Affiliation(s)
- Gaspard Gerschenfeld
- Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Groupe Henri Mondor - Albert Chenevier, Créteil, France
| | - Amandine Servy
- Service de Dermatologie et Centre de Référence des dermatoses bulleuses immunologiques et toxiques, Assistance Publique - Hôpitaux de Paris, Groupe Henri Mondor - Albert Chenevier, Créteil, France
| | - Laurence Valeyrie-Allanore
- Service de Dermatologie et Centre de Référence des dermatoses bulleuses immunologiques et toxiques, Assistance Publique - Hôpitaux de Paris, Groupe Henri Mondor - Albert Chenevier, Créteil, France
| | - Nicolas de Prost
- Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Groupe Henri Mondor - Albert Chenevier, Créteil, France/Université Paris est Créteil, Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Créteil, France
| | - Jérôme Cecchini
- Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Groupe Henri Mondor - Albert Chenevier, Créteil, France/Université Paris est Créteil, Faculté de Médecine de Créteil, Groupe de Recherche Clinique CARMAS, Créteil, France
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The effect of leflunomide on the eye dryness in secondary Sjögren's syndrome associated with rheumatoid arthritis and in rheumatoid arthritis patients. Clin Rheumatol 2014; 33:925-30. [PMID: 24647977 DOI: 10.1007/s10067-014-2548-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 01/25/2014] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
The aim of this work was to clarify the effect of leflunomide (LEF) on the eye dryness in patients with secondary Sjögren's syndrome associated with rheumatoid arthritis (RA-sSS) and in patients with rheumatoid arthritis (RA). Seventy-five female patients, 45 with RA-sSS (group A) and 30 with RA (group B), taking methotrexate at a dose of 20 mg/week for more than 6 months were enrolled in this study. They all had a loading dose of leflunomide then were maintained at a dose of 20 mg/day in addition to methotrexate for another 3 months. The modified disease activity score (DAS28) was calculated and modified Schirmer's-I test was performed. Assessment of disease parameters was done to all patients before and after 3 months of taking LEF. The mean modified Schirmer's-I test showed a significant decrease after 3 months of taking LEF in group A (3 ± 1.6 before versus 1.9 ± 1.6 after 3 months, P < 0.001), while this difference was non-significant in group B (21.3 ± 10 versus 19.9 ± 11). One patient (group A) developed peripheral ulcerative keratitis (PUK) with exacerbation of disease activity (DAS-28 = 6.9) that improved by taking corticosteroids. Three patients (group A) had aggravation of punctate keratocojunctivitis sicca with punctate erosions without PUK. The condition improved dramatically by stopping LEF and using topical lubricants. We report in this study a significant deterioration of the eye dryness in patients with sSS-RA after 3 months of receiving LEF inspite of the significant improvement of their DAS28. This finding was not clearly detected in RA patients. Close monitoring of eye dryness changes by special tests in patients using LEF is recommended, especially in cases with sSS-RA having very low baseline values.
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9
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Je JH, Lee HJ, Na YJ, Seo JH, Seo YH, Kim JH, Choi SJ, Lee YH, Ji JD, Song GG. Leflunomide-induced Toxic Epidermal Necrolysis in a Patient with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.6.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ji Hye Je
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hyun Jung Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ju Na
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Ji Hye Seo
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ho Seo
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jae-Hoon Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Leflunomide-induced DRESS syndrome with renal involvement and vasculitis. Clin Rheumatol 2012; 32:689-93. [DOI: 10.1007/s10067-012-2152-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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11
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Boyd AS. Leflunomide in dermatology. J Am Acad Dermatol 2012; 66:673-9. [DOI: 10.1016/j.jaad.2011.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/23/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
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12
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Peponis V, Kyttaris VC, Chalkiadakis SE, Bonovas S, Sitaras NM. Ocular side effects of anti-rheumatic medications: what a rheumatologist should know. Lupus 2010; 19:675-82. [PMID: 20144965 DOI: 10.1177/0961203309360539] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nearly every drug may cause changes to ocular tissues through a variety of mechanisms. Medication overdoses, drug-drug interactions but also chronic administration of medications at the recommended doses may lead to ocular toxicity. The ocular side effects, screening for eye toxicity and treatment guidelines for anti-inflammatory and immunosuppressive drugs commonly used by rheumatologists are reviewed herein.
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Affiliation(s)
- V Peponis
- Athens Eye Hospital, Second Eye Clinic, Athens, Greece
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13
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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