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Habibi MA, Alesaeidi S, Zahedi M, Hakimi Rahmani S, Piri SM, Tavakolpour S. The Efficacy and Safety of Rituximab in ANCA-Associated Vasculitis: A Systematic Review. BIOLOGY 2022; 11:biology11121767. [PMID: 36552276 PMCID: PMC9774915 DOI: 10.3390/biology11121767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Background and aim: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare multisystem autoimmune disease developed by autoantibody production against human neutrophilic granulocytes, including proteinase-3 (PR3) and myeloperoxidase (MPO). The management of AAV patients is difficult due to the multiorgan involvement, high rate of relapse, and complications of immunosuppressive agents that make it challenging. This study aims to investigate the efficacy and safety of rituximab (RTX) therapy in patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) subtypes. Method: The PubMed/Medline database was searched for any studies related to RTX therapy in ANCA-associated vasculitis (GPA and MPA subtypes), from inception to 1 August 2022, and proceeded in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Our search resulted in 1082 initial records. After the elimination of review papers, irrelevant studies, and non-English records, 223 articles were included, and the data related to the efficacy and safety of RTX therapy were extracted. Several randomized and non-randomized studies showed that RTX is an effective treatment option for patients with AAV. Most of the studies showed the very effective effect of RTX in controlling disease in AAV patients, including pediatrics, adults, and elderlies, although RTX cannot completely prevent relapse. However, maintenance therapy helps delay the disease's relapse and causes sustained remission. Not only the licensed dose (375 mg/m2 intravenous per week for 4 weeks) could induce disease remission, but studies also showed that a single infusion of RTX could be effective. Although RTX could resolve many rare manifestations in AAV patients, there are few reports showing treatment failure. Additionally, few sudies have reported the unexpeted worsening of the disease after RTX administration. Generally, RTX is relatively safe compared to conventional therapies, but some serious adverse effects, mainly infections, cytopenia, hypogammaglobinemia, malignancy, and hypersensitivity have been reported. Conclusions: RTX is an effective and relatively safe therapeutic option for AAV. Studies on the evaluation of the safety profiles of RTX and the prevention of severe RTX-related side effects in AAV patients are required.
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Affiliation(s)
- Mohammad Amin Habibi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom 3719964797, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 982166757001, Iran
| | - Samira Alesaeidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 982188220065, Iran
| | - Mohadeseh Zahedi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom 3719964797, Iran
| | - Samin Hakimi Rahmani
- Clinical Research Development Center, Qom University of Medical Sciences, Qom 3719964797, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran P.O. Box 982166757001, Iran
| | - Soheil Tavakolpour
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
- Correspondence: ; Tel.: +1-(617)-906-2978
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Filikci Z, Jensen RM, Thorup Sellebjerg F. Inflammatory vaginitis associated with long-term rituximab treatment in a patient with multiple sclerosis. BMJ Case Rep 2022; 15:15/11/e250425. [DOI: 10.1136/bcr-2022-250425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe inflammatory vaginitis as a potential side effect of long-term rituximab treatment for multiple sclerosis in the absence of any other systemic disease or underlying malignancy.More studies are needed to characterise the incidence of inflammatory vaginitis among women on long-term rituximab therapy.
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Klumpp A, Luessi F, Engel S, Weidenthaler-Barth B, Becker D, Grabbe S, Schepler H. Ocrelizumab-induced vulvovaginal pyoderma gangrenosum in a patient with relapsing-remitting multiple sclerosis. JAAD Case Rep 2022; 28:24-27. [PMID: 36097621 PMCID: PMC9463556 DOI: 10.1016/j.jdcr.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Breneman AN, Eber AE, Haque H, Levine L, Askanase A, Riley CS, Pomeranz MK, Hassan D, Mancebo SE, Polin M, Melamed A, Bordone LA, Rosser M, Gockley A, Gallitano SM. Vulvovaginal Pyoderma Gangrenosum in a Patient Treated With Ocrelizumab for Multiple Sclerosis. J Low Genit Tract Dis 2022; 26:189-191. [PMID: 35256568 DOI: 10.1097/lgt.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alyssa N Breneman
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ariel E Eber
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Hoosna Haque
- Division of Gynecology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Libby Levine
- Department of Neurology and Multiple Sclerosis Center, Columbia University Irving Medical Center, New York, NY
| | - Anca Askanase
- Department of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Claire S Riley
- Department of Neurology and Multiple Sclerosis Center, Columbia University Irving Medical Center, New York, NY
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | - Dahlia Hassan
- Department of Rheumatology, Columbia University Irving Medical Center, New York, NY
| | - Silvia E Mancebo
- Department of Dermatology, Weill Medical College of Cornell University, New York, NY
| | - Melanie Polin
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lindsey A Bordone
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Mary Rosser
- Division of Gynecology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Allison Gockley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Abstract
OBJECTIVE To summarize clinical outcomes of paradoxical pyoderma gangrenosum (PG) onset in patients on biologic therapy. METHODS The authors conducted MEDLINE and EMBASE searches using PRISMA guidelines to include 57 patients (23 reports). RESULTS Of the included patients, 71.9% (n = 41/57) noted PG onset after initiating rituximab, 21.1% (n = 12/57) noted tumor necrosis factor α (TNF-α) inhibitors, 5.3% (n = 3/57) reported interleukin 17A inhibitors, and 1.8% (n = 1/57) reported cytotoxic T-lymphocyte-associated protein 4 antibodies. The majority of patients (94.3%) discontinued biologic use. The most common medications used to resolve rituximab-associated PG were intravenous immunoglobulins, oral corticosteroids, and antibiotics, with an average resolution time of 3.3 months. Complete resolution of PG in TNF-α-associated cases occurred within an average of 2.2 months after switching to another TNF-α inhibitor (n = 1), an interleukin 12/23 inhibitor (n = 2), or treatment with systemic corticosteroids and cyclosporine (n = 3), systemic corticosteroids alone (n = 1), or cyclosporine alone (n = 1). CONCLUSIONS Further investigations are warranted to determine whether PG onset is associated with underlying comorbidities, the use of biologic agents, or a synergistic effect. Nevertheless, PG may develop in patients on rituximab or TNF-α inhibitors, suggesting the need to monitor and treat such adverse effects.
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6
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Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature. J Pers Med 2022; 12:jpm12020289. [PMID: 35207776 PMCID: PMC8876139 DOI: 10.3390/jpm12020289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis that mimics gynecologic cancer. In GPA patients, the genitourinary system is affected in <1%. The objective of the study was to provide a systematic review of the literature of GPA patients with gynecological involvement. (2) Methods: PubMed and Embase were searched from inception to July 2021 for GPA patients with gynecological involvement Medical Subject Headings (MeSH) and free-text terms. Exclusion criteria were other language, review articles, pregnancy, fertility, or male patients. Data were extracted on clinical evolution, symptoms, examinations findings, diagnosis delay, treatment, outcome, patient status, and follow-up. (3) Results: Seventeen studies included data from patients with GPA and primary or relapsed gynecological involvement. 68% of the authors of this review thought the patient had cancer. The main gynecological symptom is bleeding, but exclusive gynecologic symptomatology is rare (ENT: 63%, lungs: 44%, kidneys-urinary tract: 53%). GPA could affect all areas of the genital tract, but the most frequent location is the uterine cervix. Medical treatment for GPA is effective. (4) Conclusions: GPA of the female genital tract must be considered when biopsies of an ulcerated malignant-appearing cervical or vaginal mass are negative for malignancy even when they are unspecific. Rheumatology consultation is indicated.
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7
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Yockey L, Dowst S, Zonozi R, Huizenga N, Murphy P, Laliberte K, Rosenthal J, Niles JL, Mitchell CM. Inflammatory vaginitis in women on long-term rituximab treatment for autoimmune disorders. BMC WOMENS HEALTH 2021; 21:285. [PMID: 34353326 PMCID: PMC8340364 DOI: 10.1186/s12905-021-01423-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022]
Abstract
Background Consequences of long-term B cell depletion with rituximab are not well understood. We describe inflammatory vaginitis as a potential side effect of long-term rituximab treatment, distinct from previously described vulvovaginal pyoderma gangrenosum. Methods We performed a retrospective analysis of women treated with rituximab for more than 1 year to determine the prevalence and clinical characteristics of vaginitis cases. We conducted a case–control analysis with up to 3 controls for each vaginitis case. Results We identified sixteen inflammatory vaginitis cases. Women with vaginitis were age 23–68 (median 42), primarily being treated for ANCA-associated vasculitis (11/16; 69%). Most reported copious vaginal discharge (100%) and pain with sex (75%). All women with return of circulating B-cells to > 10 cells/mL had complete (5/9) or significant (4/9) improvement in symptoms. In case–control analysis there was no significant difference in length of B-cell depletion, immune parameters, creatinine levels, and history of neutropenia. Conclusion Inflammatory vaginitis is a potential side effect of prolonged continuous B cell depletion with rituximab. More studies are needed to characterize the incidence and etiology of vaginitis among women on long term rituximab therapy and establish a causal relationship.
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Affiliation(s)
- Laura Yockey
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Dowst
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Reza Zonozi
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Noah Huizenga
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Murphy
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Laliberte
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Jillian Rosenthal
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - John L Niles
- Division of Nephrology, Vasculitis and Glomerulonephritis Clinic, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline M Mitchell
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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8
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Sotzen JR, Stratman EJ. Vulvovaginal pyoderma gangrenosum associated with rituximab use in 2 patients with rheumatoid arthritis. JAAD Case Rep 2021; 10:75-77. [PMID: 33778138 PMCID: PMC7985273 DOI: 10.1016/j.jdcr.2021.02.013] [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
Affiliation(s)
| | - Erik J. Stratman
- Correspondence to: Dr. Erik J. Stratman, Department of Dermatology, Marshfield Clinic, 3P2, 1000 N Oak Ave, Marshfield, WI 54449.
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9
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Haber R, Dib N, El Gemayel M, Makhlouf M. Paradoxical neutrophilic dermatosis induced by biologics and immunosuppressive drugs: A systematic review. J Am Acad Dermatol 2021; 85:1048-1049. [PMID: 33607180 DOI: 10.1016/j.jaad.2021.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Roger Haber
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, Balamand University, El-Koura, Lebanon.
| | - Nicole Dib
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - Maria El Gemayel
- Department of Gastroenterology, Hotel-Dieu de France Hospital, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Milissa Makhlouf
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon; Faculty of Medicine, Balamand University, El-Koura, Lebanon
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10
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Aggarwal P. Pyoderma gangrenosum adverse event with Rituximab use: A postmarketing pharmacovigilance analysis. Dermatol Ther 2020; 33:e13221. [PMID: 31925868 DOI: 10.1111/dth.13221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/29/2019] [Indexed: 12/11/2022]
Abstract
Rituximab is a monoclonal antibody that is used for the treatment of certain malignancies and autoimmune conditions. Pyoderma gangrenosum is a rare painful ulcer that can be fatal in some cases and can also reoccur after treatment. The objective of this paper was to analyze whether a statistically significant signal exists between Rituximab and pyoderma gangrenosum in the Food and Drug Administration Adverse Event Reporting System (FAERS). A disproportionality analysis was carried out on cases from January 1, 2004 to March 31, 2019 in the FAERS. Frequentist methods of relative reporting ratio, reporting odds ratio (ROR), and proportional reporting ratio (PRR) and the Bayesian-based IC025 metric were used in order to assess the adverse event signal. Thirty-two cases were found in FAERS in which the drug Rituximab was administered and pyoderma gangrenosum was reported as an adverse event. The lower 95% CI of the information component was 0.97, the lower 95% CI of ROR was 2.18, the PRR was 3.09 and Chi-squared was 42.16, which indicates a statistically significant signal. The signal is supported by six case reports in the literature that describe a total of 14 patients who developed pyoderma gangrenosum after Rituximab administration. When administering Rituximab, clinicians should monitor for the occurrence of symptoms representing pyoderma gangrenosum.
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11
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Vikse J, Jonsdottir K, Kvaløy JT, Wildhagen K, Omdal R. Tolerability and safety of long-term rituximab treatment in systemic inflammatory and autoimmune diseases. Rheumatol Int 2019; 39:1083-1090. [PMID: 30923955 DOI: 10.1007/s00296-019-04272-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/02/2019] [Indexed: 01/21/2023]
Abstract
Rituximab, an anti-CD20 monoclonal antibody causing selective B-cell depletion, is used for various systemic inflammatory and autoimmune diseases (SIADs). Long-term safety data on rituximab are limited. The objectives of this study were to evaluate the long-term safety and tolerability of rituximab treatment for SIADs. A retrospective, single-center observational study including all patients ≥ 16 years treated with rituximab for SIADs was performed. The electronic medical records were reviewed, and data concerning indication and duration of rituximab treatment, prior and concurrent immunosuppressive therapy, and adverse events such as infections requiring hospitalization, dysgammaglobulinemia and end organ damage, were collected. A total of 70 patients were included, with a median treatment duration of 54 months, ranging 30-138 months. The most common indications for rituximab treatment were granulomatosis with polyangiitis (22.9%), primary Sjögren's syndrome (20.0%) and systemic lupus erythematosus (14.3%). Infections and persistent dysgammaglobulinemia were the most common adverse events, occurring in 34.3% and 25.7%, respectively. A total of 64 infections were observed in 24 (34.3%) patients, including 1 case of fatal infection. Seventeen patients performed B-cell quantitation during the first 2 years following discontinuation, of which only four (19.0%) demonstrated B-cell reconstitution. End organ damage occurred in two patients, presenting as pyoderma gangrenosum and interstitial pneumonitis. No opportunistic infections were observed. Three patients died during the observational period, of which one was due to lethal infection. This study presents observational data with long treatment duration. It demonstrates that long-term rituximab treatment is relatively well tolerated, and that no cumulative side effects were observed.
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Affiliation(s)
- Jens Vikse
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway
| | | | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Klaus Wildhagen
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway
| | - Roald Omdal
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
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Affiliation(s)
| | - Gina Rohekar
- Schulich School of Medicine and Dentistry, London, Canada.,Department of Medicine, Division of Rheumatology, Western University, London, Canada
| | - Fiona E Lovegrove
- Schulich School of Medicine and Dentistry, London, Canada.,Lovegrove Dermatology, London, Canada
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13
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Maloney C, Blickenstaff N, Kugasia A, Buford LB, Hoffman MD. Vulvovaginal pyoderma gangrenosum in association with rituximab. JAAD Case Rep 2018; 4:907-909. [PMID: 30302361 PMCID: PMC6176040 DOI: 10.1016/j.jdcr.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Catherine Maloney
- Rush University College of Medicine, Chicago, Illinois.,Department of Dermatology, Rush University Medical Center, Chicago, Illinois
| | | | - Aman Kugasia
- Department of Rheumatology, Rush University Medical Center, Chicago, Illinois
| | | | - Mark D Hoffman
- Department of Dermatology, Rush University Medical Center, Chicago, Illinois
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14
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Song H, Lahood N, Mostaghimi A. Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series. Br J Dermatol 2018; 178:363-368. [PMID: 28742926 DOI: 10.1111/bjd.15850] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Treatment regimens for refractory cases are nonstandardized. Intravenous immunoglobulin (IVIG) is an emerging treatment with reported success, but the efficacy of IVIG for PG is unknown. In this systematic review of cases and case series, we assessed the efficacy of IVIG for the treatment of PG, as observed at our institution and reported in the literature. A retrospective chart review at two tertiary care hospitals between 2000 and 2015, and literature searches in PubMed/MEDLINE, EMBASE and Web of Science from all years were conducted. In total, there were 49 patients, including 43 patients from 26 articles and six institutional cases. There was complete or partial response in 43 (88%) patients and complete response in 26 (53%) patients. The mean time to initial response to treatment and treatment length were 3·5 (SD 3·3) weeks and 5·9 (SD 7·8) months, respectively. On average, 2·6 treatments had been trialled before IVIG initiation. IVIG was administered with systemic steroids in 43 (88%) cases. Mild adverse events, especially nausea and headache, were reported in 12 (24·5%) patients. Our systematic review suggests a potential role for IVIG as adjuvant therapy for refractory PG. Prospective clinical trials testing the efficacy of IVIG for refractory PG are needed to validate these findings.
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Affiliation(s)
- H Song
- Harvard Medical School, Boston, MA, U.S.A
| | - N Lahood
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, U.S.A
| | - A Mostaghimi
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, U.S.A.,Department of Dermatology, Brigham and Women's Hospital, 75 Francis Street, PBB-B 421, Boston, MA, 02115, U.S.A
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15
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Vallini V, Andreini R, Bonadio A. Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One. INT J LOW EXTR WOUND 2017; 16:191-201. [DOI: 10.1177/1534734617710980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.
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Affiliation(s)
- Valerio Vallini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
| | - Roberto Andreini
- Ospedale Santa Maria Maddalena–Volterra, Azienda Usl Nordovest, Toscana, Italy
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