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Tegtmeyer K, Atassi G, Zhao J, Maloney NJ, Lio PA. Off-Label studies on anakinra in dermatology: a review. J DERMATOL TREAT 2020; 33:73-86. [PMID: 32279586 DOI: 10.1080/09546634.2020.1755417] [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] [Indexed: 01/01/2023]
Abstract
Purpose: Anakinra (Kineret®) is an interleukin-1 receptor antagonist (IL-1Ra) FDA approved for use in rheumatoid arthritis and in neonatal-onset multisystem inflammatory disease (NOMID). It has been used off-label for a variety of dermatologic conditions. A review of the available studies and cases of these off-label uses would be valuable to the dermatologist considering alternative treatments for these oftentimes poorly studied conditions.Materials and methods: The PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov databases were searched with the term 'anakinra.' Results were manually screened to identify published data on off-label uses of anakinra in dermatologic conditions and systemic conditions with prominent dermatologic manifestations.Results: Anakinra appears to show efficacy for numerous dermatologic conditions, with the strongest evidence for hidradenitis suppurativa, Bechet's disease, Muckle-Wells syndrome, and SAPHO syndrome. Case reports and case series data are available for numerous other dermatologic conditions.Conclusion: Anakinra is a potential option for patients with certain difficult-to-treat dermatologic diseases, given its relatively benign adverse effect profile and its effectiveness in a wide array of conditions. Overall, anakinra appears to be a promising option in the treatment of numerous dermatologic inflammatory conditions refractory to first line therapies, but further and higher-quality data is needed to clarify its therapeutic role.
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Affiliation(s)
- Kyle Tegtmeyer
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giancarlo Atassi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey Zhao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nolan J Maloney
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter A Lio
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Néel A, Henry B, Barbarot S, Masseau A, Perrin F, Bernier C, Kyndt X, Puechal X, Weiller PJ, Decaux O, Ninet J, Hot A, Aouba A, Astudillo L, Berthelot JM, Bonnet F, Brisseau JM, Cador B, Closs-Prophette F, Dejoie T, de Korwin JD, Dhote R, Fior R, Grosbois B, Hachulla E, Hatron PY, Jardel H, Launay D, Lorleac'h A, Pottier P, Moulis G, Serratrice J, Smail A, Hamidou M. Long-term effectiveness and safety of interleukin-1 receptor antagonist (anakinra) in Schnitzler's syndrome: a French multicenter study. Autoimmun Rev 2014; 13:1035-41. [PMID: 25220180 DOI: 10.1016/j.autrev.2014.08.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/03/2014] [Indexed: 02/07/2023]
Abstract
The aim of this study is to assess the long-term effectiveness and safety of IL1Ra in Schnitzler syndrome (SchS). Between 2010 and 2012, we performed a nationwide survey among French internal medicine departments to identify SchS patients. We retrospectively analyzed the long-term efficacy and safety of IL1Ra and the outcome of patients that did not receive this treatment. Forty-two patients were included in the study, 29 of whom received IL1Ra. The mean age at disease onset was 59.9years. Disease manifestations included urticaria (100%), fever (76%), bone/joint pain (86%), bone lesions (76%), anemia (67%), and weight loss (60%). The monoclonal gammopathy was overwhelmingly IgM kappa (83%). The mean follow-up was 9.5years (range: 1.6-35). Two patients developed Waldenström's macroglobulinemia and one developed AA amyloidosis. All of the 29 patients who received IL1Ra responded dramatically. After a median follow-up of 36months (range: 2-79), the effectiveness remained unchanged. All patients remained on anti-IL-1 therapy. Twenty-four patients (83%) went into complete remission and five (17%) into partial remission. Three patients experienced grade 3-4 neutropenia. Six patients developed severe infections. No lymphoproliferative diseases occurred while on IL1Ra. When last seen, all patients without anakinra had an active disease with variable impact on their quality of life. Their median corticosteroids dosage was 6mg/d (range: 5-25). IL1Ra is effective in SchS, with a sharp corticosteroid-sparing effect. Treatment failures should lead to reconsider the diagnosis. Long-term follow-up revealed no loss of effectiveness and a favorable tolerance profile. The long-term effects on the risk of hemopathy remain unknown.
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Affiliation(s)
- Antoine Néel
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France.
| | - Benoit Henry
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | | | - Agathe Masseau
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | - François Perrin
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France
| | - Claire Bernier
- CHU de Nantes, Service de Dermatologie, F 44093 Nantes, France
| | - Xavier Kyndt
- CH de Valenciennes, Service de Médecine Interne-Néphrologie, F 59322 Valenciennes, France
| | - Xavier Puechal
- CHU Cochin (AP-HP), Département de Médecine Interne, F 75014 Paris, France
| | - Pierre-Jean Weiller
- CHU la Timone (AP-HM; Aix-Marseille Université), Service de Médecine Interne, F 13385 Marseille, France
| | - Olivier Decaux
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France; Université Rennes 1, UMR CNRS 6290 IGRD, 35042 Rennes, France
| | - Jacques Ninet
- CHU Edouard Herriot (HCL), Service de Médecine Interne, F 69437 Lyon, France
| | - Arnaud Hot
- CHU Edouard Herriot (HCL), Service de Médecine Interne, F 69437 Lyon, France
| | - Achille Aouba
- CHU Antoine Béclère (AP-HP), Service de Médecine Interne et Immunologie Clinique, F 92140 Clamart, France
| | | | | | - Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, F 33075 Bordeaux, France
| | | | - Bérangère Cador
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France
| | | | - Thomas Dejoie
- CHU de Nantes, Laboratoire de Biochimie, F 44093 Nantes, France
| | | | - Robin Dhote
- CHU Avicenne (AP-HP), Service de Médecine Interne, F 93009 Bobigny, France
| | - Renato Fior
- CHU Antoine Béclère (AP-HP), Service de Médecine Interne et Immunologie Clinique, F 92140 Clamart, France
| | - Bernard Grosbois
- CHU de Rennes, Service de Médecine Interne, F 35033 Rennes, France; Université Rennes 1, UMR CNRS 6290 IGRD, 35042 Rennes, France
| | - Eric Hachulla
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France; EA2686, IMPRT IFR 114, F 59037 Lille, France
| | - Pierre-Yves Hatron
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France
| | - Henry Jardel
- CH Bretagne Atlantique, Service de Médecine Interne, F 56017 Vannes, France
| | - David Launay
- CHRU de Lille, Service de Médecine Interne et Immunologie Clinique, F 59037 Lille, France; Faculté de Médecine, Université Lille Nord de France, F59037 Lille, France; EA2686, IMPRT IFR 114, F 59037 Lille, France
| | - Adrien Lorleac'h
- CH Bretagne Sud, Service de Médecine Interne et Maladies Infectieuses, F 56100 Lorient, France
| | - Pierre Pottier
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France; Faculté de Médecine, Université de Nantes, F44093 Nantes, France
| | - Guillaume Moulis
- CHU d'Amiens, Service de Médecine Interne, F 80054 Amiens, France
| | - Jacques Serratrice
- CHU la Timone (AP-HM; Aix-Marseille Université), Service de Médecine Interne, F 13385 Marseille, France
| | - Amar Smail
- CHU d'Amiens, Service de Médecine Interne, F 80054 Amiens, France
| | - Mohamed Hamidou
- CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France; Faculté de Médecine, Université de Nantes, F44093 Nantes, France
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