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Sy MY, Fromm E, Doan L, Rojek N, Brandt AU. Nicolau Syndrome After Glatiramer Acetate Injection in Close Proximity to Administration of SARS-CoV-2 mRNA Vaccine. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/1/e1112. [PMID: 34759023 PMCID: PMC8587730 DOI: 10.1212/nxi.0000000000001112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Michael Yu Sy
- From the Department of Neurology (M.Y.S., E.F., U.B), Department of Pathology (L.D.), and Department of Dermatology (N.R.), University of California, Irvine.
| | - Erin Fromm
- From the Department of Neurology (M.Y.S., E.F., U.B), Department of Pathology (L.D.), and Department of Dermatology (N.R.), University of California, Irvine
| | - Linda Doan
- From the Department of Neurology (M.Y.S., E.F., U.B), Department of Pathology (L.D.), and Department of Dermatology (N.R.), University of California, Irvine
| | - Nathan Rojek
- From the Department of Neurology (M.Y.S., E.F., U.B), Department of Pathology (L.D.), and Department of Dermatology (N.R.), University of California, Irvine
| | - Alexander Ulrich Brandt
- From the Department of Neurology (M.Y.S., E.F., U.B), Department of Pathology (L.D.), and Department of Dermatology (N.R.), University of California, Irvine
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Ciprian S, Lava SAG, Milani GP, Bianchetti MG, Consolascio D, Lardelli PF. Nicolau syndrome caused by Glatiramer. Mult Scler Relat Disord 2022; 57:103365. [PMID: 35158471 DOI: 10.1016/j.msard.2021.103365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022]
Abstract
Injection-site reactions to glatiramer are common and include erythema, pruritus, pain, or induration. Additionally, the present systematic review of the literature documents 20 cases of Nicolau syndrome following glatiramer, a rare but potentially severe skin reaction. Abdomen and thighs are the most frequently affected areas (80% of reported cases), and permanent skin damage has been observed in 30% of cases. Recurrences are rare (<10%).
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Affiliation(s)
- Sandro Ciprian
- Pediatric Cardiology Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Institute of Southern Switzerland EOC, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Danilo Consolascio
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro F Lardelli
- Family Medicine Institute, Università della Svizzera Italiana, Lugano, Switzerland
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Blind A, Lenormand C, Schissler C, Cribier B, Lipsker D. Dermite livédoïde de Nicolau sus-pubienne après injections sous-cutanées d’acétate de glatiramère. Ann Dermatol Venereol 2018; 145:671-675. [DOI: 10.1016/j.annder.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 01/13/2023]
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Mott SE, Peña ZG, Spain RI, White KP, Ehst BD. Nicolau syndrome and localized panniculitis: a report of dual diagnoses with an emphasis on morphea profunda-like changes following injection with glatiramer acetate. J Cutan Pathol 2016; 43:1056-1061. [DOI: 10.1111/cup.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 06/13/2016] [Accepted: 08/08/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Sarah E. Mott
- School of Medicine; Creighton University; Omaha NE USA
| | - Zachary G. Peña
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
| | - Rebecca I. Spain
- Department of Neurology; Oregon Health and Sciences University; Portland OR USA
| | - Kevin P. White
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
- Department of Dermatopathology; Oregon Health and Sciences University; Portland OR USA
| | - Benjamin D. Ehst
- Department of Dermatology; Oregon Health and Sciences University; Portland OR USA
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Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
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Affiliation(s)
| | | | - Sylvia Hsu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Kass
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St., 9th Floor, Houston, TX, 77030, USA.
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Starossom SC, Veremeyko T, Dukhinova M, Yung AWY, Ponomarev ED. Glatiramer acetate (copaxone) modulates platelet activation and inhibits thrombin-induced calcium influx: possible role of copaxone in targeting platelets during autoimmune neuroinflammation. PLoS One 2014; 9:e96256. [PMID: 24788965 PMCID: PMC4008572 DOI: 10.1371/journal.pone.0096256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Glatiramer acetate (GA, Copaxone, Copolymer-1) is an FDA approved drug for the treatment of MS and it is very effective in suppressing neuroinflammation in experimental autoimmune encephalitis (EAE), an animal model of MS. Although this drug was designed to inhibit pathogenic T cells, the exact mechanism of EAE/MS suppression by GA is still not well understood. Previously we presented evidence that platelets become activated and promote neuroinflammation in EAE, suggesting a possible pathogenic role of platelets in MS and EAE. We hypothesized that GA could inhibit neuroinflammation by affecting not only immune cells but also platelets. Methodology/Principal Findings We investigated the effect of GA on the activation of human platelets in vitro: calcium influx, platelet aggregation and expression of activation markers. Our results in human platelets were confirmed by in-vitro and in-vivo studies of modulation of functions of platelets in mouse model. We found that GA inhibited thrombin-induced calcium influx in human and mouse platelets. GA also decreased thrombin-induced CD31, CD62P, CD63, and active form of αIIbβ3 integrin surface expression and formation of platelet aggregates for both mouse and human platelets, and prolonged the bleeding time in mice by 2.7-fold. In addition, we found that GA decreased the extent of macrophage activation induced by co-culture of macrophages with platelets. Conclusions GA inhibited the activation of platelets, which suggests a new mechanism of GA action in suppression of EAE/MS by targeting platelets and possibly preventing their interaction with immune cells such as macrophages. Furthermore, the reduction in platelet activation by GA may have additional cardiovascular benefits to prevent thrombosis.
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Affiliation(s)
- Sarah C. Starossom
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute for Medical Immunology and NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tatyana Veremeyko
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Marina Dukhinova
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Amanda W. Y. Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Eugene D. Ponomarev
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
- * E-mail:
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Necrotizing skin lesion and radial nerve palsy in a patient treated with glatiramer acetate. J Neurol Sci 2013; 331:172-3. [PMID: 23778027 DOI: 10.1016/j.jns.2013.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 04/22/2013] [Accepted: 05/23/2013] [Indexed: 11/23/2022]
Abstract
Glatiramer acetate (GA) is an approved and well tolerated drug for the treatment of relapsing-remitting multiple sclerosis. We report a case of a 52 year-old man with psoriasis and relapsing-remitting multiple sclerosis who developed, after 21 months of GA treatment, an injection-site cutaneous necrosis that involved both subcutaneous and muscular tissue with massive edema, followed, 3 days later, by radial nerve palsy. After few days another similar lesion appeared in another injection-site. We hypothesize that cutaneous necrosis could be due to a local dis-immune reaction and, probably, psoriasis could have played an important role in its pathogenesis.
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Balak DMW, Hengstman GJD, Çakmak A, Thio HB. Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review. Mult Scler 2012; 18:1705-17. [PMID: 22371220 DOI: 10.1177/1352458512438239] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for multiple sclerosis (MS). DMTs can be associated with cutaneous adverse events, which may influence treatment adherence and patient quality of life. In this systematic review, we aimed to provide an overview of the clinical spectrum and the incidence of skin reactions associated with DMTs. A systematic literature search was performed up to May 2011 in Medline, Embase, and Cochrane databases without applying restrictions in study design, language, or publishing date. Eligible for inclusion were articles describing any skin reaction related to DMTs in MS patients. Selection of articles and data extraction were performed by two authors independently. One hundred and six articles were included, of which 41 (39%) were randomized controlled trials or cohort studies reporting incidences of mainly local injection-site reactions. A large number of patients had experienced some form of localized injection-site reaction: up to 90% for those using subcutaneous formulations and up to 33% for those using an intramuscular formulation. Sixty-five case-reports involving 106 MS patients described a wide spectrum of cutaneous adverse events, the most frequently reported being lipoatrophy, cutaneous necrosis and ulcers, and various immune-mediated inflammatory skin diseases. DMTs for MS are frequently associated with local injection-site reactions and a wide spectrum of generalized cutaneous adverse events, in particular, the subcutaneous formulations. Although some of the skin reactions may be severe and persistent, most of them are mild and do not require cessation of DMT.
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Affiliation(s)
- Deepak M W Balak
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Martínez-Morán C, Espinosa-Lara P, Nájera L, Romero-Maté A, Córdoba S, Hernández-Núñez A, Borbujo J. Embolia Cutis Medicamentosa (Nicolau Syndrome) After Glatiramer Acetate Injection. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Embolia cutis medicamentosa (síndrome de Nicolau) tras inyección de acetato de glatirámero. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:742-4. [DOI: 10.1016/j.ad.2010.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/09/2010] [Accepted: 12/17/2010] [Indexed: 11/21/2022] Open
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Abstract
BACKGROUND This is an updated Cochrane review of the previous version published (Cochrane Database of Systematic Reviews 2004 , Issue 1 . Art. No.: CD004678. DOI: 10.1002/14651858.CD004678)Previous studies have shown that glatiramer acetate (Copaxone (R)), a synthetic amino acid polymer is effective in experimental allergic encephalomyelitis (EAE), and improve the outcome of patients with multiple sclerosis (MS). OBJECTIVES To verify the clinical efficacy of glatiramer acetate in the treatment of MS patients with relapsing remitting (RR) and progressive (P) course. SEARCH STRATEGY We searched the Cochrane MS Group Trials Register (26 March 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2009), MEDLINE (PubMed) (January 1966 to 26 March 2009), EMBASE (January 1988 to 26 March 2009) and hand searching of symposia reports (1990-2009). SELECTION CRITERIA All randomised controlled trials (RCTs) comparing glatiramer acetate and placebo in patients with definite MS, whatever the administration schedule and disease course, were eligible for this review. DATA COLLECTION AND ANALYSIS Both patients with RR and P MS were analysed. Study protocols were comparable across trials. No major flaws were found in methodological quality. However, efficacy of blinding should be balanced against side effects, including injection-site reactions. MAIN RESULTS Among 409 retrieved references, we identified 16 RCTs; six of them, published between 1987 and 2007, met the selection criteria and were included in this review. Five hundred and forty RR patients and 1049 PMS contributed to the analysis. In RR MS, a decrease in the mean EDSS score (-0.33 and -0.45), was found respectively at 2 years and 35 months without any significant effect on sustained disease progression. The reduction of mean number of relapse was evident at 1 year (-0.35 ) 2 years (-0.51 ) and 35 months (-0.64), but significant studies ' heterogeneity was found. The number of hospitalisations and steroid courses were significantly reduced. No benefit was shown in P MS patients. No major toxicity was found. The most common systemic adverse event was a transient and self-limiting patterned reaction of flushing, chest tightness, sweating, palpitations, anxiety. Local injection-site reactions were observed in up to a half of patients treated with glatiramer acetate, thus making a blind assessment of outcomes questionable. AUTHORS' CONCLUSIONS Glatiramer acetate did show a partial efficacy in RR MS in term of relapse -related clinical outcomes, without any significant effect on clinical progression of disease measured as sustained disability. The drug is not effective in progressive MS patients.
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Affiliation(s)
- Loredana La Mantia
- Department of Neuroscience, Fondazione I.R.C.C.S. - Istituto Neurologico C. Besta, Via Celoria, 11, Milano, Italy, 20133
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Cicek D, Kandi B, Oguz S, Cobanoglu B, Bulut S, Saral Y. An urticarial vasculitis case induced by glatiramer acetate. J DERMATOL TREAT 2009; 19:305-7. [DOI: 10.1080/09546630801961067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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John Wiley & Sons, Ltd.. Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1375] [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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