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Béné J, Moulis G, Auffret M, Lefevre G, Coquerelle P, Coupe P, Péré P, Gautier S. Alopecia induced by tumour necrosis factor-alpha antagonists: description of 52 cases and disproportionality analysis in a nationwide pharmacovigilance database. Rheumatology (Oxford) 2014; 53:1465-9. [PMID: 24681837 DOI: 10.1093/rheumatology/keu145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this research was to describe the cases of TNF-α antagonist-related alopecia reported in the French Pharmacovigilance Database (FPVD) and to investigate the association between exposure to TNF-α antagonists and occurrence of alopecia. METHODS All spontaneous reports of TNF-α antagonist-related alopecia recorded in the FPVD between January 2000 and April 2012 were colligated and described. We conducted disproportionality analyses (case/non-case method) to assess the link between the occurrence of alopecia and exposure to TNF-α antagonists. Cases were all reports of alopecia and non-cases were all other reports recorded during the study period. Exposure to TNF-α antagonists was sought in cases and in non-cases. Reporting odds ratios (RORs) were calculated to assess the association. Docetaxel was used as positive control and acetaminophen as negative control. We performed sensitivity analyses excluding cases of androgenic alopecia and those occurring in psoriatic patients. RESULTS Among 282 590 spontaneous reports of adverse drug reactions (ADRs) collated in the FPVD, 1068 cases (alopecia reports) were identified. Of these cases, 52 (4.9%) occurred during exposure to TNF-α antagonists (18 involved infliximab, 17 adalimumab, 15 etanercept and 2 certolizumab). Exposure to TNF-α antagonists was more frequent among alopecia reports than among other ADR reports for all TNF-α antagonists pooled (ROR 3.0, 95% CI 2.3, 4.0) as well as for each antagonist separately, with similar values. Sensitivity analyses yielded similar results. The RORs were 29.9 (95% CI 25.3, 35.5) with docetaxel and 0.3 (95% CI 0.2, 0.4) with acetaminophen. CONCLUSION The present study confirms a strong link between TNF-α antagonist exposure (class effect) and the occurrence of alopecia.
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Affiliation(s)
- Johana Béné
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.
| | - Guillaume Moulis
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Marine Auffret
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Guillaume Lefevre
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Pascal Coquerelle
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Patrick Coupe
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Patrice Péré
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
| | - Sophie Gautier
- Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France.Regional Centre of Pharmacovigilance, Lille University Hospital, University of Lille 2, Lille, Internal Medicine Department, Toulouse University Hospital, University of Toulouse, UMR INSERM-UPS 1027, Toulouse, Internal Medicine and Clinical Immunology Department, Lille University Hospital, Immunology Laboratory EA2686, Lille University Hospital, Lille, Rheumatology Department, Bethune Hospital, Bethune, Department of Pharmacy, Valenciennes Hospital, Valenciennes and Rheumatology Department, Nancy University Hospital, Nancy, France
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