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Xue Y, Cohen JM, Wright NA, Merola JF. Skin Signs of Rheumatoid Arthritis and its Therapy-Induced Cutaneous Side Effects. Am J Clin Dermatol 2016; 17:147-62. [PMID: 26649439 DOI: 10.1007/s40257-015-0167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that primarily affects the joints, but may exhibit extra-articular, including cutaneous, manifestations such as rheumatoid nodules, rheumatoid vasculitis, granulomatous skin disorders, and neutrophilic dermatoses. A large burden of cutaneous disease may be an indication of RA disease activity and the need for more aggressive treatment. Many of the therapeutic agents used to treat RA can also result in cutaneous adverse effects, which pose their own diagnostic and therapeutic challenges. Anti-TNFα agents, in particular, have a wide variety of adverse effects including psoraisiform eruptions, granulomatous conditions, and cutaneous connective tissue disorders. Herein we provide an update on the clinical presentations and management of RA-associated cutaneous findings as well as drug-induced cutaneous effects, with particular attention to the adverse effects of biologic disease-modifying agents.
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Sehgal VN, Pandhi D, Khurana A. Biologics in dermatology: adverse effects. Int J Dermatol 2015; 54:1442-60. [PMID: 26147909 DOI: 10.1111/ijd.12802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/13/2014] [Accepted: 06/25/2014] [Indexed: 12/13/2022]
Abstract
Biologics are a group of drugs that precisely affect certain specific steps in the immune response and are an extremely useful group when used in an appropriate setting. However, their use can often be a double-edged sword. Careful patient selection and thorough knowledge of adverse effects is a key to their successful use in various disorders. The initial enthusiasm has gradually given way to a more cautious approach wherein a balance is sought between clinical usefulness and expected side effects. The adverse effects of the biologics most commonly used in dermatology have been carefully listed for ready reference. The plausible causes of the adverse reactions are succinctly outlined along with their incriminating factor(s). Besides, in brief, the attention has been focused on their management. The content should provide an essential didactic content for educating the practitioner.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, Delhi, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences, and Associated Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Ananta Khurana
- Department of Dermatology and STD, Dr RML hospital and PGIMER, New Delhi, India
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Broshtilova V, Iliev E, Gantcheva M. Etanercept-induced Wegener granulomatosis in a patient with rheumatoid arthritis. Dermatol Ther 2013; 26:73-6. [DOI: 10.1111/j.1529-8019.2012.01538.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Valentina Broshtilova
- Department of Dermatology and Venereology; Faculty of Medicine; Sofia Medical University
| | - Emil Iliev
- Department of Dermatology and Venereology; Faculty of Medicine; Sofia Medical University
| | - Mary Gantcheva
- Institute of Experimental Morphology, Pathology and Anthropology with Museum; Bulgarian Academy of Science; Sofia; Bulgaria
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Batycka-Baran A, Flaig M, Molin S, Ruzicka T, Prinz JC. Etanercept-induced injection site reactions: potential pathomechanisms and clinical assessment. Expert Opin Drug Saf 2012; 11:911-21. [DOI: 10.1517/14740338.2012.727796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Effective treatment with etanercept results from a congregation of immunological signaling and modulating roles played by tumor necrosis factor-alpha (TNF-alpha), a pervasive member of the TNF super-family of cytokines participating in numerous immunologic and metabolic functions. Macrophages, lymphocytes and other cells produce TNF as part of the deregulated immune response resulting in psoriasis or other chronic inflammatory disorders. Tumor necrosis factor is also produced by macrophages and lymphocytes responding to foreign antigens as a primary response to potential infection. Interference with cytokine signaling by etanercept yields therapeutic response. At the same time, interference with cytokine signaling by etanercept exposes patients to potential adverse events. While the efficacy of etanercept for the treatment of psoriasis is evident, the risks of treatment continue to be defined. Of the potential serious adverse events, response to infection is the best characterized in terms of physiology, incidence, and management. Rare but serious events: activation of latent tuberculosis, multiple sclerosis, lymphoma, and others, have been observed but have questionable or yet to be defined association with therapeutic uses of etanercept. The safe use of etanercept for the treatment of psoriasis requires an appreciation of potential adverse events as well as screening and monitoring strategies designed to manage patient risk
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Affiliation(s)
- Kim A Papp
- University of Western Ontario, and K Papp Clinical Research Waterloo, ON, Canada
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Moustou AE, Matekovits A, Dessinioti C, Antoniou C, Sfikakis PP, Stratigos AJ. Cutaneous side effects of anti-tumor necrosis factor biologic therapy: a clinical review. J Am Acad Dermatol 2009; 61:486-504. [PMID: 19628303 DOI: 10.1016/j.jaad.2008.10.060] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 10/17/2008] [Accepted: 10/27/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-tumor necrosis factor (anti-TNF) biologic agents have been associated with a number of adverse events. OBJECTIVE To review the cutaneous reactions that have been reported in patients receiving anti-TNF therapy. METHODS We performed a systematic MEDLINE search of relevant publications, including case reports and case series. RESULTS Reported cutaneous events included infusion and injection site reactions, psoriasiform eruptions, lupus-like disorders, vasculitis, granulomatous reactions, cutaneous infections, and cutaneous neoplasms. Infusion reactions and injection site reactions were definitely associated with anti-TNF administration, whereas all other events had a varying strength of association and severity, not necessarily requiring drug discontinuation. LIMITATIONS Most information was derived from spontaneous case reports, where ascertainment biases and frequency of reporting may impair detection methodology and causal relationships. CONCLUSIONS As anti-TNF biologic agents are progressively being used in clinical practice, cutaneous adverse events will be encountered more frequently. Until more data are accumulated with respect to their pathogenesis and potential association with anti-TNF therapy, dermatologists should become more familiar with the clinical presentation and management of such events.
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Scheinfeld N. A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab. J DERMATOL TREAT 2009; 15:280-94. [PMID: 15370396 DOI: 10.1080/09546630410017275] [Citation(s) in RCA: 217] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
For more than 5 years, infliximab and etanercept have been utilized to treat rheumatoid arthritis and Crohn's disease. There is therefore much post-approval data on their side effects. A variety of Medline searches were done at the beginning of June 2004 using the terms 'etanercept', 'infliximab' and 'adalimumab' and the words 'lymphoma', 'infection', 'congestive heart failure', 'demyelinating disease', 'lupus', 'antibodies', 'injection site reaction', 'systemic', 'side effects' and 'skin'. Approximately 150 articles were so identified. In addition, FDA and manufacturers' data obtained by internet searches using Google were reviewed. The important side effects that have been most extensively related to TNFalpha blockers include: lymphoma, infections, congestive heart failure, demyelinating disease, a lupus-like syndrome, induction of auto-antibodies, injection site reactions, and systemic side effects. The risk of these side effects is very low. Nevertheless, it is important for clinicians to be aware of these side effects when prescribing therapy.
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Affiliation(s)
- N Scheinfeld
- Department of Dermatology, St Luke's Roosevelt Hospital Center, New York, NY 10025, USA.
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Mössner R, Schön MP, Reich K. Tumor necrosis factor antagonists in the therapy of psoriasis. Clin Dermatol 2008; 26:486-502. [DOI: 10.1016/j.clindermatol.2007.10.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Davaine AC, Saraux A, Prigent S, Kupfer-Bessaguet I, Roswag D, Plantin P, Schoenlaub P, Talarmin F, Zagnoli A, Misery L. Cutaneous events during treatment of chronic inflammatory joint disorders with anti-tumour necrosis factor alpha: a cross-sectional study. J Eur Acad Dermatol Venereol 2008; 22:1471-7. [PMID: 18713230 DOI: 10.1111/j.1468-3083.2008.02935.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anti-tumour necrosis factors (anti-TNF) are more and more used, but the rate of skin adverse events is not known. OBJECTIVE The aim was to assess the number of skin infections and other dermatoses in patients treated with anti-TNFalpha. PATIENTS AND METHODS One hundred eighty-seven patients suffering from rheumatoid arthritis or ankylosing spondylitis underwent a dermatological exam. Patients with anti-TNF were compared with those without this treatment in a prospective transversal study. RESULTS Among them, 59 patients were treated with anti-TNFalpha and steroids were prescribed in 100 cases. There was no difference in the prevalence of skin infections or eczema or tumours. Skin drug reactions were observed in six patients. Infections by dermatophytes appear very frequent, approaching 70% in both groups. CONCLUSIONS This study shows that skin infections (or other skin diseases) are not more frequent in these patients. No differences were observed in infections (bacterial fungal, parasital or viral), tumours, psoriasis or the manifestations of atopic dermatitis. Nonetheless, a long-term survey might be interesting, especially about skin tumours.
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Affiliation(s)
- A C Davaine
- Department of Dermatology, University Hospital, Brest, France
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Lee A, Kasama R, Evangelisto A, Elfenbein B, Falasca G. Henoch-Schönlein purpura after etanercept therapy for psoriasis. J Clin Rheumatol 2007; 12:249-51. [PMID: 17023811 DOI: 10.1097/01.rhu.0000239901.34561.5e] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Etanercept is a recombinant dimeric fusion protein consisting of a tumor necrosis factor-alpha receptor ligand-binding region linked to the Fc portion of human IgG. It is approved for use in the treatment of rheumatoid arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis, and psoriatic arthritis. Since 1998, there have been reports of vasculitic adverse events, including necrotizing vasculitis and leukocytoclastic vasculitis. In addition, the adverse events reporting system of the U.S. Food and Drug Administration has recorded 35 cases of leukocytoclastic vasculitis, 20 after etanercept therapy and 15 after infliximab. Most cases of cutaneous vasculitis describe development of symptoms within 3 months of etanercept use. In only one case report was direct immunofluorescence performed on tissue and no specific immunoreactivity found. We describe the first case of Henoch-Schönlein purpura with acute renal failure associated with increase in etanercept dose after 11 months of use for treatment of psoriasis. Discontinuation of the drug and treatment with a course of systemic steroids led to the complete resolution of the vasculitis and improvement of renal function. Vasculitis occurring even during chronic use of antitumor necrosis factor agents must be considered as possibly related to the therapy.
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Affiliation(s)
- Annabelle Lee
- Division of Rheumatology, the Department of Clinical Medicine, Cooper University Hospital, UMDNJ-Robert Wood Johnson Medical School at Camden, Camden, New Jersey 08103, USA.
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Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic suppurative condition which is poorly responsive to treatment and is characterized by significant morbidity. Successful treatment of HS in patients treated with infliximab for concomitant Crohn's disease has been reported. More recent reports of positive responses to infliximab [an antitumour necrosis factor (TNF)-alpha agent] in patients who have HS but not Crohn's disease are encouraging. OBJECTIVES TNF-alpha is implicated in many inflammatory disorders and we wished to determine the efficacy of subcutaneous etanercept, a competitive inhibitor of TNF-alpha in the control of HS symptoms. METHODS We commenced six patients with severe, recalcitrant HS on etanercept (25 mg subcutaneously twice weekly in all cases). All patients had a normal chest X-ray and negative purified protein derivative test prior to treatment and were closely monitored throughout the treatment period for signs of infection. Patients self-assessed their disease activity and completed Dermatology Life Quality Index (DLQI) questionnaires immediately before the introduction of therapy and 24 weeks later in the case of four patients, and 12 weeks later in the case of two others. All patients were asked to estimate the time lapse between commencement of treatment and initial response. RESULTS Treatment was well tolerated by all patients with no reported adverse reactions. A marked reduction in self-reported disease activity (mean reduction of 61% at 24 weeks), in DLQI scores (mean reduction of 64% at 24 weeks) and in relapse rates occurred. All patients rated etanercept as their most effective treatment to date. CONCLUSIONS Our results show the effectiveness of etanercept in this group of patients with particularly challenging disease. Etanercept, unlike infliximab, may be administered subcutaneously, rendering costly day-case admissions unnecessary.
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Affiliation(s)
- C Cusack
- Dermatology Department, Waterford Regional Hospital, Waterford, Ireland.
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Stratigos AJ, Sfikakis PP. Psoriasis occurring during anti-TNF-α therapy: causal effect or unrelated? ACTA ACUST UNITED AC 2006. [DOI: 10.2217/17460816.1.3.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mukhtyar C, Luqmani R. Current state of tumour necrosis factor {alpha} blockade in Wegener's granulomatosis. Ann Rheum Dis 2005; 64 Suppl 4:iv31-6. [PMID: 16239383 PMCID: PMC1766905 DOI: 10.1136/ard.2005.042416] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tumour necrosis factor alpha (TNFalpha) is likely to be involved in the pathogenesis of Wegener's granulomatosis. This paper reviews published clinical trials of the anti-TNFalpha agents etanercept and infliximab with regard to their efficacy and safety in the treatment of Wegener's granulomatosis. On the basis of the high rate of adverse events, particularly an increased incidence of cancers, the use of etanercept in the management of Wegener's granulomatosis is not justified. However, the potential role for infliximab or the as yet untested adalimumab cannot be discounted. The development of novel approaches focusing on blockade of specific molecules including TNFalpha in the treatment of Wegener's granulomatosis is awaited.
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Affiliation(s)
- C Mukhtyar
- Rheumatology Department, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Abstract
Etanercept (Enbrel, Wyeth Pharmaceuticals) is a fusion protein composed of a soluble TNF alpha receptor issued from bio-technology. It is a member of TNF alpha's family with two others marked infliximab (Remicade, Scheringh Plough Laboratory), chimeric monoclonal antibody (25 p. 100 mouse) and adalimumab (Humira, Abbott France Laboratory), humanized monoclonal antibody (100 p. 100 human). In United States, etanercept is approved by Food and Drug Administration, since 1998, to treat rheumatoid arthritis showing an inadequate response to prior therapy with other disease-modifying antirheumatic drugs (DMARDS). In France, the MA (Marketing Authorization) is more recent, in 2000, etanercept to treat active rheumatoid arthritis who showed an inadequate response to others DMARDS (like methotrexate for example), with opportunity, in 2002, to administer etanercept in active, severe RA, in first line treatment without previous use of methotrexate. Others MA have been obtained in ankylosing spondylitis (2004) polyarticular-course juvenile rheumatoid arthritis (2000), and in the treatment of psoriasic arthritis (2002). Request of MA have been realised to treat cutaneous mild to severe psoriasis in adult, which failed to respond, contradication or no tolerance with systemic treatment as methotrexate, cyclosporine or phototherapy. Among the others anti-TNF therapy, only infliximab can be prescribed, in dermatology, to treat psoriatic arthritis in France. Encouraging good results were the subject of cases report, but lacking clinical trial, predicting probably administration of etanercept in others indications in future. TNF alpha is a proinflammatory cytokine and plays an important role in the physiopathology of large inflammatory diseases. Logically, in future, we should increased prescription of biotherapy, particularly anti-TNF alpha. We have to mind short or mild-term adverse events, widely described in the literature, but long-term side effects remained unknown. Moreover, these biotherapic agents have a high cost and should be estimate.
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Affiliation(s)
- A Sparsa
- Service de Dermatologie, Hôpital Universitaire Dupuytren, Limoges.
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Abstract
This report details the pulmonary pathologic findings in four patients with rheumatoid arthritis, who developed new onset of pulmonary signs and symptoms with alveolar infiltrates temporally related to the institution of etanercept therapy. Biopsy findings showed an interstitial and air space lymphohistiocytic infiltrate with non-necrotizing granulomas, in the setting of negative cultures and special stains for microorganisms. The association with etanercept therapy and granulomatous reactions is discussed along with the differential diagnosis.
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Affiliation(s)
- Samuel A Yousem
- The Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213-2582, USA.
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Flendrie M, Vissers WHPM, Creemers MCW, de Jong EMGJ, van de Kerkhof PCM, van Riel PLCM. Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther 2005; 7:R666-76. [PMID: 15899052 PMCID: PMC1174960 DOI: 10.1186/ar1724] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 02/25/2005] [Accepted: 03/01/2005] [Indexed: 12/18/2022] Open
Abstract
Various dermatological conditions have been reported during tumor necrosis factor (TNF)-α-blocking therapy, but until now no prospective studies have been focused on this aspect. The present study was set up to investigate the number and nature of clinically important dermatological conditions during TNF-α-blocking therapy in patients with rheumatoid arthritis (RA). RA patients starting on TNF-α-blocking therapy were prospectively followed up. The numbers and natures of dermatological events giving rise to a dermatological consultation were recorded. The patients with a dermatological event were compared with a group of prospectively followed up RA control patients, naive to TNF-α-blocking therapy and matched for follow-up period. 289 RA patients started TNF-α-blocking therapy. 128 dermatological events were recorded in 72 patients (25%) during 911 patient-years of follow-up. TNF-α-blocking therapy was stopped in 19 (26%) of these 72 patients because of the dermatological event. More of the RA patients given TNF-α-blocking therapy (25%) than of the anti-TNF-α-naive patients (13%) visited a dermatologist during follow-up (P < 0.0005). Events were recorded more often during active treatment (0.16 events per patient-year) than during the period of withdrawal of TNF-α-blocking therapy (0.09 events per patient-year, P < 0.0005). The events recorded most frequently were skin infections (n = 33), eczema (n = 20), and drug-related eruptions (n = 15). Other events with a possible relation to TNF-α-blocking therapy included vasculitis, psoriasis, drug-induced systemic lupus erythematosus, dermatomyositis, and a lymphomatoid-papulosis-like eruption. This study is the first large prospective study focusing on dermatological conditions during TNF-α-blocking therapy. It shows that dermatological conditions are a significant and clinically important problem in RA patients receiving TNF-α-blocking therapy.
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Affiliation(s)
- Marcel Flendrie
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Wynand HPM Vissers
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marjonne CW Creemers
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Elke MGJ de Jong
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Peter CM van de Kerkhof
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Piet LCM van Riel
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Sellam J, Allanore Y, Batteux F, Deslandre CJ, Weill B, Kahan A. Autoantibody induction in patients with refractory spondyloarthropathy treated with infliximab and methotrexate. Joint Bone Spine 2005; 72:48-52. [PMID: 15681248 DOI: 10.1016/j.jbspin.2004.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 03/05/2004] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Induction of antinuclear antibodies (ANA) has been reported in patients taking infliximab to treat refractory spondyloarthropathy, without concomitant methotrexate therapy. We investigated antibody induction in patients with spondyloarthropathy treated with both infliximab and methotrexate. METHODS In 33 patients meeting ESSG criteria for spondyloarthropathy, infliximab was given (infusions at weeks 0, 2, 6, 14, 22, and 30) in combination with methotrexate (10-25 mg/week). At baseline, 6 and 30 weeks after treatment initiation, the patients underwent indirect immunofluorescence testing for ANA and ELISAs for antibodies to double-stranded DNA, soluble nuclear antigens, and histones. RESULTS As compared to baseline, significant increases were found at week 30 in the number of patients with ANA (4% vs. 29%, P = 0.02), IgG antihistone antibodies (7% vs. 29%, P = 0.04), and IgM antihistone antibodies (29% vs. 57%, P = 0.03). No significant increases were noted for antibodies to double-stranded DNA or to soluble nuclear antigens. No cases of clinical lupus syndrome were recorded. CONCLUSION Autoantibody induction was far less common in our patients than in the population studied by De Rycke et al. [Arthritis Rheum. 48 (2003) 1015], who found ANA in 88.6% and antibodies to double-stranded DNA in 17.1% of 35 patients taking infliximab without methotrexate. Methotrexate may reduce the risk of autoantibody induction and disimmunity associated with infliximab therapy.
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Affiliation(s)
- Jérémie Sellam
- Rheumatology Department A, Paris V University, Cochin Teaching Hospital, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Hyrich KL, Silman AJ, Watson KD, Symmons DPM. Anti-tumour necrosis factor alpha therapy in rheumatoid arthritis: an update on safety. Ann Rheum Dis 2004; 63:1538-43. [PMID: 15242866 PMCID: PMC1754871 DOI: 10.1136/ard.2004.024737] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Anti-TNFalpha therapy may have associated risks of serious infection, congestive heart failure, malignancy, and multiple sclerosis. The magnitude of these risks is difficult to assess. This article reviews publications on the current knowledge about the safety of these agents.
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Affiliation(s)
- K L Hyrich
- ARC Epidemiology Unit, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Stratigos AJ, Antoniou C, Stamathioudaki S, Avgerinou G, Tsega A, Katsambas AD. Discoid lupus erythematosus-like eruption induced by infliximab. Clin Exp Dermatol 2004; 29:150-3. [PMID: 14987271 DOI: 10.1111/j.1365-2230.2004.01471.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lupus erythematosus-like syndromes have been reported as an adverse effect of anti-tumour necrosis factor-alpha therapy. We report the case of a patient with rheumatoid arthritis who developed a discoid lupus erythematosus-like eruption after treatment with infliximab. The rash consisted of diffuse scaly erythematous plaques on the face, trunk and extremities, and occurred in the context of elevated anti-nuclear and anti-double-stranded DNA antibody titres. Direct immunofluorescence of lesional skin showed linear deposition of IgG, IgM and C3. The lesions resolved completely after the discontinuation of infliximab and with the use of anti-malarial therapy. We discuss the clinical, histological and immunohistochemical features of this case and review the literature with respect to the incidence of lupus erythematosus-like syndromes in patients receiving tumour necrosis factor-alpha antagonists.
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Affiliation(s)
- A J Stratigos
- Department of Dermatology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:529-44. [PMID: 12426939 DOI: 10.1002/pds.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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