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Wijburg MT, Warnke C, McGuigan C, Koralnik IJ, Barkhof F, Killestein J, Wattjes MP. Pharmacovigilance during treatment of multiple sclerosis: early recognition of CNS complications. J Neurol Neurosurg Psychiatry 2021; 92:177-188. [PMID: 33229453 DOI: 10.1136/jnnp-2020-324534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022]
Abstract
An increasing number of highly effective disease-modifying therapies for people with multiple sclerosis (MS) have recently gained marketing approval. While the beneficial effects of these drugs in terms of clinical and imaging outcome measures is welcomed, these therapeutics are associated with substance-specific or group-specific adverse events that include severe and fatal complications. These adverse events comprise both infectious and non-infectious complications that can occur within, or outside of the central nervous system (CNS). Awareness and risk assessment strategies thus require interdisciplinary management, and robust clinical and paraclinical surveillance strategies. In this review, we discuss the current role of MRI in safety monitoring during pharmacovigilance of patients treated with (selective) immune suppressive therapies for MS. MRI, particularly brain MRI, has a pivotal role in the early diagnosis of CNS complications that potentially are severely debilitating and may even be lethal. Early recognition of such CNS complications may improve functional outcome and survival, and thus knowledge on MRI features of treatment-associated complications is of paramount importance to MS clinicians, but also of relevance to general neurologists and radiologists.
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Affiliation(s)
- Martijn T Wijburg
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Clemens Warnke
- Department of Neurology, University Hospital Köln, University of Cologne, Köln, Germany.,Department of Neurology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Christopher McGuigan
- Department of Neurology, St Vincent's University Hospital & University College Dublin, Dublin, Ireland
| | - Igor J Koralnik
- Department of Neurological Sciences, Division of Neuroinfectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology & Nuclear Medicine, MS Center Amsterdam, Neuroscience Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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Beatty PE, Killion L, Callaghan G, Tierney E, Kelly G, Tobin AM. A case series of persistent lymphopaenia following treatment with fumaric acid esters for psoriasis. J Clin Pharm Ther 2021; 46:859-861. [PMID: 33432649 DOI: 10.1111/jcpt.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 12/12/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Fumaric acid esters (FAEs) have been used for fifty years to treat moderate-to-severe psoriasis. However, recent case reports of progressive multifocal leukoencephalopathy, associated with FAE-induced lymphopaenia, have been a cause for concern (J Dtsch Dermatol Ges. 2009;7:603). CASE SERIES We report six cases of persistent lymphopaenia following cessation of treatment with FAEs, with a mean duration of lymphopaenia of 33 months. WHAT IS NEW AND CONCLUSION Given the lack of evidence regarding expected recovery of lymphocyte counts, further research is required to guide physicians in the risk stratification of patients prior to considering treatment with FAEs.
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Affiliation(s)
| | - Lisa Killion
- Tallaght University Hospital, Dublin, Ireland.,Tallaght Hospital, Dublin, Ireland
| | - Grainne Callaghan
- Tallaght University Hospital, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
| | - Emma Tierney
- Tallaght University Hospital, Dublin, Ireland.,Tallaght Hospital, Dublin, Ireland
| | - Genevieve Kelly
- Tallaght University Hospital, Dublin, Ireland.,Tallaght Hospital, Dublin, Ireland
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3
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Bavaro DF, Fiordelisi D, Angarano G, Monno L, Saracino A. Targeted therapies for autoimmune/idiopathic nonmalignant diseases: risk and management of opportunistic infections. Expert Opin Drug Saf 2020; 19:817-842. [PMID: 32394759 DOI: 10.1080/14740338.2020.1767585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The management of patients affected by autoimmune/idiopathic diseases has been revolutionized by the development of targeted therapies (TT). However, the use of TT is complicated by several adverse events, like opportunistic infections (OIs). The potential of TT to predispose to OIs mainly depends on the site of action; nevertheless, such associations are far from being deterministic, because many factors could increase the infection risk. AREAS COVERED The impact on the infective risk of different TT used for autoimmune/idiopathic diseases is far from being completely understood. Indeed, many post-marketing reports documented severe or unexpected infections in patients treated with TT that did not emerge during registrative trials. In this review, the authors attempt to provide an easy and practical update about the 'infectious' safety of TT and examine the management strategies of OIs and other infections more frequently observed in the course of treatment with TT. EXPERT OPINION The authors suggest to precisely schedule the clinical management of these subjects, both to prevent and eventually treat promptly the TT-related infectious complications. A coordinated approach should be implemented from different medical specialties to improve the overall understanding of safety of TT and, in general, the management of opportunistic infections in immune-compromised hosts.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Deborah Fiordelisi
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Gioacchino Angarano
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Laura Monno
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro" , Bari, Italy
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D’Alessandro S, Scaccabarozzi D, Signorini L, Perego F, Ilboudo DP, Ferrante P, Delbue S. The Use of Antimalarial Drugs against Viral Infection. Microorganisms 2020; 8:microorganisms8010085. [PMID: 31936284 PMCID: PMC7022795 DOI: 10.3390/microorganisms8010085] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Abstract
In recent decades, drugs used to treat malaria infection have been shown to be beneficial for many other diseases, including viral infections. In particular, they have received special attention due to the lack of effective antiviral drugs against new emerging viruses (i.e., HIV, dengue virus, chikungunya virus, Ebola virus, etc.) or against classic infections due to drug-resistant viral strains (i.e., human cytomegalovirus). Here, we reviewed the in vitro/in vivo and clinical studies conducted to evaluate the antiviral activities of four classes of antimalarial drugs: Artemisinin derivatives, aryl-aminoalcohols, aminoquinolines, and antimicrobial drugs.
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Affiliation(s)
- Sarah D’Alessandro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Diletta Scaccabarozzi
- Department of Pharmacological and Biomolecular Sciences, University of Milano, 20133 Milan, Italy;
| | - Lucia Signorini
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Federica Perego
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Denise P. Ilboudo
- Département des Sciences de la Vie, University of Fada N’Gourma (UFDG), Fada N’Gourma BP 54, Burkina Faso;
| | - Pasquale Ferrante
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20133 Milan, Italy; (S.D.); (L.S.); (F.P.); (P.F.)
- Correspondence: ; Tel.: +39-02-50315070
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Maul J, Navarini A, Sommer R, Anzengruber F, Sorbe C, Mrowietz U, Drach M, Blome C, Boehncke W, Thaci D, Reich K, Kiedrowski R, Körber A, Yawalkar N, Mainetti C, Laffitte E, Streit M, Rustenbach S, Conrad C, Borradori L, Gilliet M, Cozzio A, Itin P, Häusermann P, French L, Radtke M, Augustin M. Gender and age significantly determine patient needs and treatment goals in psoriasis – a lesson for practice. J Eur Acad Dermatol Venereol 2019; 33:700-708. [DOI: 10.1111/jdv.15324] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J.‐T. Maul
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - A.A. Navarini
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - R. Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - F. Anzengruber
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - C. Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - U. Mrowietz
- Department of Dermatology University Medical Center Schleswig‐Holstein Kiel Germany
| | - M. Drach
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - C. Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - W.‐H. Boehncke
- Department of Dermatology and Venereology Geneva University Hospitals Geneva Switzerland
- Department of Pathology and Immunology Geneva University Hospitals Geneva Switzerland
| | - D. Thaci
- Comprehensive Center for Inflammation Medicine University Hospital Schleswig‐Holstein Lübeck Germany
| | - K. Reich
- Dermatologikum Berlin and SCIderm Research Institute Hamburg Germany
| | | | - A. Körber
- Dermatology Practice Essen Essen Germany
| | - N. Yawalkar
- Department of Dermatology Inselspital University Hospital Bern University of Bern Bern Switzerland
| | - C. Mainetti
- Department of Dermatology Regional Hospital Bellinzona Bellinzona Switzerland
| | - E. Laffitte
- Department of Dermatology and Venereology Geneva University Hospitals Geneva Switzerland
| | - M. Streit
- Department of Dermatology Cantonal Hospital Aarau Aarau Switzerland
| | - S. Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - C. Conrad
- Department of Dermatology University Hospital Lausanne Lausanne Switzerland
| | - L. Borradori
- Department of Dermatology Inselspital University Hospital Bern University of Bern Bern Switzerland
| | - M. Gilliet
- Department of Dermatology University Hospital Lausanne Lausanne Switzerland
| | - A. Cozzio
- Department of Dermatology Cantonal Hospital St. Gallen St. Gallen Switzerland
| | - P. Itin
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - P. Häusermann
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - L.E. French
- Department of Dermatology University Hospital Zurich Zurich Switzerland
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Mrowietz U, Barker J, Boehncke WH, Iversen L, Kirby B, Naldi L, Reich K, Tanew A, van de Kerkhof P, Warren R. Clinical use of dimethyl fumarate in moderate-to-severe plaque-type psoriasis: a European expert consensus. J Eur Acad Dermatol Venereol 2018; 32 Suppl 3:3-14. [DOI: 10.1111/jdv.15218] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
- U. Mrowietz
- Psoriasis-Centre at the Department of Dermatology; University Medical Centre Schleswig-Holstein; Kiel Germany
| | - J. Barker
- St John's Institute of Dermatology; King's College London; London UK
| | - W.-H. Boehncke
- Division of Dermatology and Venereology; Geneva University Hospitals; Geneva Switzerland
- Department of Pathology and Immunology; Faculty of Medicine; University of Geneva; Geneva Switzerland
| | - L. Iversen
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - B. Kirby
- Department of Dermatology; St. Vincent's University Hospital; Dublin Ireland
| | - L. Naldi
- Centro Studi GISED; Bergamo Italy
- Department of Dermatology; Ospedale san Bortolo di Vicenza; Vicenza Italy
| | - K. Reich
- Dermatologikum Berlin and SCIderm Research Institute; Hamburg Germany
| | - A. Tanew
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - R.B. Warren
- Dermatology Centre; Salford Royal NHS Foundation Trust; Salford UK
- Manchester Academic Health Science Centre; Manchester NIHR Biomedical Research Centre; The University of Manchester; Manchester UK
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Perini P, Rinaldi F, Puthenparampil M, Marcon M, Perini F, Gallo P. Herpes simplex virus encephalitis temporally associated with dimethyl fumarate-induced lymphopenia in a multiple sclerosis patient. Mult Scler Relat Disord 2018; 26:68-70. [PMID: 30227312 DOI: 10.1016/j.msard.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) is approved as first line therapy for relapsing-remitting multiple sclerosis (RRMS). In some (3%) patients, DMF induces a marked lymphopenia. Herpes simplex encephalitis (HSE) may occur in lymphopenic subjects under treatment with immune-suppressive drugs. CASE PRESENTATION We report a case of a 39-year-old female patient with RRMS that developed HSE temporally associated with a marked and sudden drop in lymphocyte count, from 1200/µl to 600/µl, in the peripheral blood. HSE DNA was demonstrated in the cerebrospinal fluid. HSE had the features that characterize HSE occurring in immunosuppressed subjects, i.e. less prominent CSF pleocytosis, bilateral and mainly cortical involvement and less extensive tissue necrosis. Antiviral therapy determined a progressive, although incomplete, improvement. Three months later the patient presented only a mild short-term memory deficit and sporadic episodes of inappropriate emotionality. Lymphocyte count returned to normal values (1120/µl) after DMF discontinuation. CONCLUSION Our case of HSE in a lymphopenic DMF-treated RRMS patient, points out the necessity of further studies on DMF-related lymphopenia, especially whether it implies an impaired immunity against viruses.
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Affiliation(s)
- Paola Perini
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy
| | - Marco Puthenparampil
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy.
| | | | | | - Paolo Gallo
- Multiple Sclerosis Centre of the Veneto Region, Department of Neurosciences, DNS, University Hospital of Padua, Padua Italy.
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Brück J, Dringen R, Amasuno A, Pau-Charles I, Ghoreschi K. A review of the mechanisms of action of dimethylfumarate in the treatment of psoriasis. Exp Dermatol 2018; 27:611-624. [DOI: 10.1111/exd.13548] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jürgen Brück
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - Ralf Dringen
- Faculty 2 (Biology/Chemistry); Center for Biomolecular Interactions Bremen; University of Bremen; Bremen Germany
- Center for Environmental Research and Sustainable Technology; University of Bremen; Bremen Germany
| | | | | | - Kamran Ghoreschi
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
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Tzaneva S, Geroldinger A, Trattner H, Tanew A. Fumaric acid esters in combination with a 6-week course of narrowband ultraviolet B provides an accelerated response compared with fumaric acid esters monotherapy in patients with moderate-to-severe plaque psoriasis: a randomized prospective clinical stud. Br J Dermatol 2018; 178:682-688. [DOI: 10.1111/bjd.16106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
- S. Tzaneva
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Geroldinger
- Center for Medical Statistics, Informatics and Intelligent Systems; Section for Clinical Biometrics; Medical University of Vienna; Vienna Austria
| | - H. Trattner
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Tanew
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
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11
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Pulido-Valdeolivas I, Zubizarreta I, Martinez-Lapiscina EH, Villoslada P. Precision medicine for multiple sclerosis: an update of the available biomarkers and their use in therapeutic decision making. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1393315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Irene Pulido-Valdeolivas
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Institut d’Investigacions Biomediques August Pi Sunyer (IDBAPS), University of Barcelona, Barcelona, Spain
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