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Jedlowski PM, DuPont JP. Multiple myeloma, haematologic malignancy and immunosuppressant and immunomodulatory medications are associated with sebaceous carcinoma, a pharmacovigilance study of the FDA adverse event reporting system. J Eur Acad Dermatol Venereol 2024; 38:937-944. [PMID: 38071595 DOI: 10.1111/jdv.19703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/23/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sebaceous carcinoma (SC) is a rare skin cancer with significant associated morbidity and mortality. A known association exists between immunosuppression, in particular solid organ transplant patients (SOTR), and SC. However, the comparative reporting odds ratios (ROR) of different immunosuppressive medications and SC are incompletely defined. OBJECTIVES To examine the relationship between SC and medication exposure in the FDA adverse event reporting system (FAERS). METHODS Case-control analyses were performed in FAERS from 1968 to 2021 to examine the reporting odds ratios (ROR) for SC. RESULTS A total of 58 medication-associated SC cases were identified. Immunosuppressant medication exposure was noted in 81% cases, with 20% total cases occurring in SOTR. Medications affecting the TNF- α -IL-1-IL-2-IL-6 inflammatory axis were associated with elevated ROR for SC, including thalidomide (ROR 22.63, 95% CI 5.52-92.72), lenalidomide (ROR 10.86, 95% CI 4.93-23.94), cyclosporine, tacrolimus, tocilizumab, tofacitinib and ruxolitinib. Thirty per cent of cases of SC occurred with an associated haematologic malignancy or dyscrasia, including chronic lymphocytic leukaemia, non-Hodgkin lymphoma and multiple myeloma. CONCLUSIONS SC is associated with exposure to immunosuppressive medications, especially in SOTR patients. A significant portion of cases with SC had an associated haematology malignancy, in particular multiple myeloma with exposure to lenalidomide.
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Affiliation(s)
- Patrick M Jedlowski
- Division of Dermatology, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Jason P DuPont
- Division of Dermatology, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
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Grins E, Ederoth P, Bjursten H, Dardashti A, Brondén B, Metzsch C, Erdling A, Nozohoor S, Mokhtari A, Hansson MJ, Elmér E, Algotsson L, Shrestha NM, Jovinge S. Effect of Cyclosporine on Cytokine Production in Elective Coronary Artery Bypass Grafting: A Sub-Analysis of the CiPRICS (Cyclosporine to Protect Renal Function in Cardiac Surgery) Study. J Cardiothorac Vasc Anesth 2021; 36:1985-1994. [PMID: 34969566 DOI: 10.1053/j.jvca.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The augmented inflammatory response to cardiac surgery is a recognized cause of postoperative acute kidney injury. The present study aimed to investigate the effects of preoperative cyclosporine treatment on cytokine production and delineate factors associated with postoperative kidney impairment. DESIGN A randomized, double-blind, placebo-controlled, single-center study. SETTING At a tertiary care, university hospital. PARTICIPANTS Patients eligible for elective coronary artery bypass grafting surgery; 67 patients were enrolled. INTERVENTIONS Patients were randomized to receive 2.5 mg/kg cyclosporine or placebo before surgery. Cytokine levels were measured after the induction of anesthesia and 4 hours after the end of cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS Tissue-aggressive (interleukin [IL]-1β, macrophage inflammatory protein [MIP]-1β, granulocyte colony-stimulating factor [G-CSF], IL-6, IL-8, IL-17, MCP-1), as well tissue-lenient (IL-4) cytokines, were significantly elevated in response to surgery. Changes in cytokine levels were not affected by cyclosporine pretreatment. CONCLUSIONS Elective coronary artery bypass grafting surgery with cardiopulmonary bypass triggers cytokine activation. This activation was not impacted by preoperative cyclosporine treatment.
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Affiliation(s)
- Edgars Grins
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
| | - Per Ederoth
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
| | - Alain Dardashti
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Björn Brondén
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Carsten Metzsch
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - André Erdling
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
| | - Arash Mokhtari
- Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
| | - Magnus J Hansson
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eskil Elmér
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lars Algotsson
- Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Nabin Manandhar Shrestha
- DeVos Cardiovascular Research Program, Fredrik Meijer Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand Rapids, MI
| | - Stefan Jovinge
- DeVos Cardiovascular Research Program, Fredrik Meijer Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand Rapids, MI; Cardiovascular Institute, Stanford University, Palo Alto, CA
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3
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Intravenous iron supplement for iron deficiency in cardiac transplant recipients (IronIC): A randomized clinical trial. J Heart Lung Transplant 2021; 40:359-367. [DOI: 10.1016/j.healun.2021.01.1390] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
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Sedighi S, Aghaei M, Musavi S, Nomali M. Relationship between Serum Level of Interleukin-2 in Patients with Systemic Lupus Erythematosus and Disease Activity in Comparison with Control Group. J Clin Diagn Res 2014; 8:MC16-8. [PMID: 25177590 DOI: 10.7860/jcdr/2014/7903.4602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/03/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the large number of surveys, there are not any validated biomarkers for SLE disease activity till now. This study aimed to evaluate the relationship between serum level of IL-2 in patients with SLE and disease activity in comparison with control group. MATERIALS AND METHODS In this case-control study, 73 patients with lupus and 73 healthy subjects referred to the rheumatology clinic of 5 Azar Hospital in Gorgan (North of Iran).They were studied via convenience sampling during 2011-2012. Blood samples were taken from both groups and serum levels of interleukin -2 measured by Avi Bion Human IL-2 ELISA kit. Serum Level of IL-2 greater than 15 pg/ml defined positive and lesser than this amount defined negative. Disease activity evaluated with SLE disease activity index. Score greater than or equal to three or four defined as active disease. Data analysis conducted by SPSS software (version 16) and by using descriptive statistics and statistical tests. RESULTS Serum level of IL-2 was positive in 45.2% of sample studied and negative in 54.8% in case group, while in control group, serum level of IL-2 only in 11% of sample studied was positive and in 89% was negative. Statistical analysis indicated a significant relationship between serum level of IL-2 and the SLE disease activity index (p=0.025). CONCLUSION This study showed the relationship between serum levels of IL-2 and disease activity, so this biomarker can be used as a clinical indicator for assessing disease activity in patients with SLE.
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Affiliation(s)
- Sima Sedighi
- Assistant Professor, Joint, Bone and Connective Tissue Research Centre (JBCRC), Golesatan University of Medical Sciences , Gorgan, Iran
| | - Mehrdad Aghaei
- Assistant Professor, Joint, Bone and Connective Tissue Research Centre (JBCRC), Golesatan University of Medical Sciences , Gorgan, Iran
| | - Sara Musavi
- Medical Doctor, University of Medical Sciences , Gorgan, Iran
| | - Mahin Nomali
- BSc of Nursing, Clinical Research Development Unit (CRDU), 5 Azar Hospital, Golestan University of Medical Sciences , Gorgan, Iran
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5
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Kuuliala A, Nissinen R, Kautiainen H, Repo H, Leirisalo-Repo M. Low circulating soluble interleukin 2 receptor level predicts rapid response in patients with refractory rheumatoid arthritis treated with infliximab. Ann Rheum Dis 2005; 65:26-9. [PMID: 15941839 PMCID: PMC1797973 DOI: 10.1136/ard.2004.034728] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Treatment with infliximab induces a rapid therapeutic response in most patients with active rheumatoid arthritis. Factors predicting good response are not well known. OBJECTIVE To study the predictive value of baseline level of soluble interleukin 2 receptor (sIL2R), a marker of lymphocyte activation, on the treatment response. METHODS 24 patients with active rheumatoid arthritis received intravenous infusions of infliximab at study entry, at two weeks, at six weeks, and at eight week intervals thereafter. Outcome was evaluated at six weeks and 22 weeks. Clinical assessment and standard laboratory tests were made and the DAS28 disease activity score was calculated. Serum sIL2R level at entry was measured by automated immunoassay analyser (Immulite). The mean change in DAS28 score from entry to six weeks and 22 weeks was calculated and related to sIL2R level using baseline adjusted robust regression analysis. RESULTS Baseline level of serum sIL2R (mean (SD), 621 (325) U/ml) did not correlate with baseline DAS28 score (r = 0.24 (95% confidence interval, -0.18 to 0.58)). At six weeks DAS28 scores improved, with a mean change of -2.53 (-3.08 to -1.98) (p<0.001). This change was predicted by low baseline sIL2R level (regression coefficient per 100 U/ml: 0.205 (0.003 to 0.407) (p = 0.047)). At 22 weeks the DAS28 scores improved, with a mean change of -2.26 (-2.75 to -1.77) (p<0.001). The change was not predicted by baseline sIL2R level. CONCLUSIONS Low baseline sIL2R level may predict a rapid clinical response in patients with refractory rheumatoid arthritis treated with infliximab.
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Affiliation(s)
- A Kuuliala
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Finland.
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Kallen KJ, Galle PR, Rose-John S. New developments in IL-6 dependent biology and therapy: where do we stand and what are the options? Expert Opin Investig Drugs 2005; 8:1327-49. [PMID: 15992152 DOI: 10.1517/13543784.8.9.1327] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Interleukin-6 (IL-6) is a four-helical protein which, on target cells, binds to a specific IL-6-receptor and two molecules of the promiscuous signal transducing protein gp130. Structure-function analysis defined three molecular contact sites between IL-6 and its receptor subunits. Using this information, competitive antagonistic proteins as well as hyperagonistic proteins were developed. Possible therapeutic applications of IL-6 antagonists are in IL-6 dependent haematological disorders (Castleman's disease, POEMS syndrome, multiple myeloma) and bone diseases (Paget's disease, osteoporosis). Designer IL-6 antagonists could suppress inflammatory activity in rheumatic and autoimmune diseases and could prevent secondary amyloidosis. IL-6 antagonists could also prove advantageous in myocardial infarction and unstable angina pectoris. IL-6 antagonists might slow down development of (mesangioproliferative) glomerulonephritis. On the other hand, hyperagonistic variants of IL-6 have a potential in ex vivo expansion of bone marrow stem cells and as thrombopoietic agents. They might also be developed into drugs to support liver regeneration in vivo and to treat stress-induced cardiac insufficiency.
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Affiliation(s)
- K J Kallen
- Medizinische Klinik, Abteilung Pathophysiology Johannes Gutenberg Universität Mainz, Obere Zahlbacher Str. 63, D-55101 Mainz, Germany
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Kallen KJ. The role of transsignalling via the agonistic soluble IL-6 receptor in human diseases. BIOCHIMICA ET BIOPHYSICA ACTA 2002; 1592:323-43. [PMID: 12421676 DOI: 10.1016/s0167-4889(02)00325-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The activation of cells that do not express the membrane bound interleukin-6 6 receptor (IL-6R) by IL-6 and the soluble IL-6 receptor (sIL-6R) is termed transsignalling. Transsignalling may be an pathogenetic factor in human diseases as diverse as multiple myeloma (MM), Castleman's disease, prostate carcinoma, Crohn's disease, systemic sclerosis, Still's disease, osteoporosis and cardiovascular diseases. IL-6 and sIL-6R may directly or indirectly enhance their own production on endothelial or bone marrow stromal cells. Positive feedback autocrine loops thus created in affected organs may either cause or maintain disease progression. In autoimmune or vasculitic disease, the ability of the IL-6/sIL-6R complex to inhibit apoptosis of autoreactive T-cells may be central to the development of tissue specific autoimmunity. The anti-apoptotic effect of the IL-6/sIL-6R complex may be involved in tumour genesis and resistance to chemotherapy. Only in rare cases, where counterregulation has failed, there is a notable systemic effect of IL-6/sIL-6R. Appropriate animal models are necessary to establish the pathogenetic role of the IL-6/sIL-6R complex. A specific treatment option for diseases influenced by the sIL-6R could be based on gp130-Fc, a soluble gp130 (sgp130) linked to the Fc-fragment of IgG1. gp130-Fc has shown efficacy in vivo in animal models of Crohn's disease.
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Affiliation(s)
- Karl-Josef Kallen
- Biochemisches Institut, Christian-Albrechts-Universität zu Kiel, Germany.
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Abstract
Rheumatoid arthritis is a chronic multi-system disease of unknown aetiology. The current hypothesis is that an unknown antigen triggers an autoimmune response in a genetically susceptible individual. The predominant pathological change is that of an inflammatory synovitis, characterised by cellular infiltrates and angiogenesis, with subsequent bone and cartilage destruction. These pathological changes are as a result of the activation of a variety of cells, inflammatory mediators, and effector molecules. The pro-inflammatory kinins and cytokines appear to play a central role in the pathogenesis of rheumatoid arthritis. Sufficient evidence exists that establishes a key role for the kallikrein-kinin cascade in inflamed joints. In addition, there appears to be an inter-relationship between cytokines and kinins in the inflammatory process. Kinins induce the release of cytokines, and cytokines have been shown to augment the effects of kinins. This may lead to an enhancement and perpetuation of the inflammatory process. In this review, we report a first study, correlating markers of disease with the kallikrein-kinin cascade and with cytokines.
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Affiliation(s)
- Bilkish Cassim
- Department of Rheumatology, Nelson R. Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa
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9
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Ayer LM, Issekutz AC, Waterhouse CC, Stadnyk AW. Cytokine mRNA in the joints and draining lymph nodes of rats with adjuvant arthritis and effects of cyclosporin A. Inflammation 2000; 24:447-61. [PMID: 10921508 DOI: 10.1023/a:1007064212462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
TNF-alpha and IL-1beta promote leukocyte recruitment to arthritic joints and may contribute to cartilage degradation while regulatory cytokines such as IL-4 and IL-1RA may in part determine the course of arthritis. Here we report the pattern of TNF-alpha, IL-1beta, IL-6, IFN-gamma, IL-1RA, and IL-4 mRNA expression, detected by RT/PCR, in the talar joint and draining popliteal lymph node (PLN) of rats with adjuvant arthritis (AA). Levels of TNF-alpha and IFN-gamma mRNA were increased in the PLN before clinical signs of arthritis. This was followed by increases in IL-1beta and IL-1RA mRNA at d9 and IL-6 mRNA at d12. PLN IL-1RA mRNA levels were positively correlated with those of IL-1beta and TNF-alpha throughout d5-d20. IL-4 mRNA levels were highest on days 7 and 20. In the synovium, a small increase in TNF-alpha, IL-1beta, and IL-6 mRNA was detected on d5 then again on d12. Maximal synovial TNF-alpha levels were reached on d20, while IL-1beta peak expression was on d16 and IL-6 on d14. IL-4, IL-1RA, and IFN-gamma mRNA was undetectable in the synovium. Cyclosporin treatment for 4 days, initiated at the height of arthritis, rapidly decreased clinical disease, and decreased migration of neutrophils and T lymphocytes into the joints. Yet no significant effect of CyA was observed on inflammatory cytokine expression, although the correlation between PLN IL-1RA and IL-1beta or TNF-alpha was lost in treated animals. Thus there is a variable pattern of cytokine gene expression in rat AA, the undetectable IL-4 and IFN-gamma mRNA in synovium being analogous to human rheumatoid arthritis.
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MESH Headings
- Animals
- Arthritis, Experimental/drug therapy
- Arthritis, Experimental/genetics
- Arthritis, Experimental/metabolism
- Arthritis, Rheumatoid/metabolism
- Chemotaxis, Leukocyte/drug effects
- Cyclosporine/pharmacology
- Cyclosporine/therapeutic use
- Cytokines/biosynthesis
- Cytokines/genetics
- Disease Models, Animal
- Gene Expression Regulation/drug effects
- Humans
- Hypersensitivity, Delayed/immunology
- Immunosuppressive Agents/pharmacology
- Immunosuppressive Agents/therapeutic use
- Interferon-gamma/biosynthesis
- Interferon-gamma/genetics
- Interleukin 1 Receptor Antagonist Protein
- Interleukin-1/biosynthesis
- Interleukin-1/genetics
- Interleukin-4/biosynthesis
- Interleukin-4/genetics
- Interleukin-6/biosynthesis
- Interleukin-6/genetics
- Lymph Nodes/metabolism
- Male
- Models, Animal
- RNA, Messenger/biosynthesis
- Rats
- Rats, Inbred Lew
- Reverse Transcriptase Polymerase Chain Reaction
- Sialoglycoproteins/biosynthesis
- Sialoglycoproteins/genetics
- Synovial Membrane/metabolism
- Tarsus, Animal/metabolism
- Tumor Necrosis Factor-alpha/biosynthesis
- Tumor Necrosis Factor-alpha/genetics
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Affiliation(s)
- L M Ayer
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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Spadaro A, Taccari E, Sensi F, Riccieri V, Sili Scavalli A, Zoppini A. Soluble interleukin-2 receptor and interleukin-6 levels: evaluation during cyclosporin A and methotrexate treatment in psoriatic arthritis. Clin Rheumatol 1998; 17:83-5. [PMID: 9586691 DOI: 10.1007/bf01450970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Spadaro
- Institute of Rheumatology, University La Sapienza, Rome, Italy
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Barrera P, Boerbooms AM, van de Putte LB, van der Meer JW. Effects of antirheumatic agents on cytokines. Semin Arthritis Rheum 1996; 25:234-53. [PMID: 8834013 DOI: 10.1016/s0049-0172(96)80035-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A review of the literature concerning the effects of traditional antirheumatic drugs on cytokines and the cytokine and anticytokine approaches already used in the therapy of rheumatoid arthritis (RA) is presented. Many antirheumatic drugs are capable of cytokine modulation in vitro. Corticosteroids inhibit the transcription of a broad spectrum of genes including those encoding monocyte, T cell-derived cytokines and several hemopoietic growth factors, whereas drugs such as cyclosporin A and D-penicillamine interfere with T cell activation more specifically by suppressing interleukin 2 (IL-2) production. The in vivo effects of drug therapy on cytokines in RA patients are less well established. Gold compounds reduce circulating IL-6 levels and the expression of monocyte-derived cytokines, such as IL-1, tumor necrosis factor (TNF), and IL-6, in the rheumatoid synovium. Decreases in circulating IL-6, soluble IL-2 (sIL-2R), and TNF receptors and in synovial fluid IL-1 levels have been reported with methotrexate. Reductions in circulating IL-6 and sIL-2R concentrations have also been observed with cyclosporin and corticosteroids, whereas azathioprine reduces IL-6 but not sIL-2R. Studies on sulfasalazine are conflicting and the in vivo effects of D-penicillamine and antimalarials have not been studied yet. Interferon gamma therapy is not effective in RA but may prove a useful antifibrotic for systemic sclerosis. Colony stimulating factors improve the granulocytopenia associated with Felty's syndrome or drug toxicities but can induce arthritis flares and should be reserved to treat infectious complications. Promising results are being obtained with selective antagonism of TNF and IL-1 in RA, and combinations of anticytokine strategies with traditional antirheumatic drugs have been already envisaged. These should preferably be based in a broader knowledge of the effects of antirheumatic agents on the cytokine network.
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Affiliation(s)
- P Barrera
- Department of Rheumatology, University Hospital Nijmegen, Netherlands
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