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Guilleminault L, Carré P, Beau-Salinas F, Taillé C, Dieudé P, Crestani B, Diot P, Marchand-Adam S. Asthma unmasked with tumor necrosis factor-α-blocking drugs. Chest 2011; 140:1068-1071. [PMID: 21972387 DOI: 10.1378/chest.10-2350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We report five cases of asthma unmasked by anti-tumor necrosis factor (TNF)-α-blocking drugs. Asthma symptoms appeared within an average of 4 months (range 1-24 months) after starting the anti-TNF-α treatment for inflammatory disease. The patients did not appear to be predisposed to asthma except for one patient who had asthma during childhood. Four patients stopped anti-TNF-α-blocking drugs with an improvement of symptoms within 1 to 5 months. In the patient with a history of childhood asthma, respiratory symptoms recurred when another anti-TNF-α therapy was started. Asthma control was achieved with inhaled steroids, allowing anti-TNF-α treatment to continue. The biotherapy was maintained for the fifth patient in association with inhaled steroids. The pathophysiologic mechanisms are unknown but are probably more complex than the T helper 1/T helper 2 imbalance suggested in the literature, and further studies are required.
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Affiliation(s)
- Laurent Guilleminault
- Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France.
| | - Philippe Carré
- Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France
| | - Frédérique Beau-Salinas
- Hôpital Bretonneau, Department of Clinical Pharmacology/Regional Centre of Pharmacovigilance, CHRU Tours, Tours, France
| | - Camille Taillé
- Service de Pneumologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France; Unité INSERM U700, Faculté de X. Bichat, Université René Descartes, Paris, France
| | - Philippe Dieudé
- Service de rhumatologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Bruno Crestani
- Service de Pneumologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France; Unité INSERM U700, Faculté de X. Bichat, Université René Descartes, Paris, France
| | - Patrice Diot
- Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France
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Ramos-Casals M, Perez-Alvarez R, Perez-de-Lis M, Xaubet A, Bosch X. Pulmonary disorders induced by monoclonal antibodies in patients with rheumatologic autoimmune diseases. Am J Med 2011; 124:386-94. [PMID: 21531225 DOI: 10.1016/j.amjmed.2010.11.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/29/2010] [Accepted: 11/01/2010] [Indexed: 12/11/2022]
Abstract
Monoclonal antibodies have emerged as a new class of agents causing drug-related pulmonary involvement in patients with systemic rheumatologic autoimmune diseases. The most frequently associated noninfectious pulmonary diseases are interstitial pneumonia (118 cases reported by August 2010), sarcoid-like disease and vasculitis (40 cases), and 97% of cases are associated with agents blocking tumor necrosis factor (TNF), a cytokine implicated in pulmonary fibrosis, granuloma formation, and maintenance. Drug-induced interstitial pneumonia has a poor prognosis, with an overall mortality rate of around one-third, rising to two-thirds in patients with pre-existing interstitial disease. Sarcoid-like disease has a better prognosis, with resolution or improvement in 90% of cases. Although the evidence comes overwhelmingly from case reports and case series, suggested recommendations for patient management include a detailed pre-therapeutic evaluation, early identification of symptoms suggestive of pulmonary disease, and tailored therapy. Mycobacterial infection should be exhaustively investigated, especially after anti-TNF administration. Large, prospective, postmarketing studies including nonbiological agents as controls may help elucidate the real risk of pulmonary disease in patients with rheumatologic autoimmune diseases receiving monoclonal antibodies.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases Josep Font, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
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Silva LCR, Ortigosa LCM, Benard G. Anti-TNF-α agents in the treatment of immune-mediated inflammatory diseases: mechanisms of action and pitfalls. Immunotherapy 2010; 2:817-33. [DOI: 10.2217/imt.10.67] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
TNF-α is a potent inducer of the inflammatory response, a key regulator of innate immunity and plays an important role in the regulation of Th1 immune responses against intracellular bacteria and certain viral infections. However, dysregulated TNF can also contribute to numerous pathological situations. These include immune-mediated inflammatory diseases (IMIDs) including rheumatoid arthritis, Crohn’s disease, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis and severe chronic plaque psoriasis. Animal and human studies concerning the role of TNF-α in IMIDs have led to the development of a therapy based on TNF blockage. This article focuses first on the potential mechanisms by which the three currently licensed agents, adalimumab, etarnecept and infliximab, decrease the inflammatory activity of patients with different IMIDs. Second, it focuses on the risks, precautions and complications of the use of TNF-α inhibitors in these patients.
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Affiliation(s)
- Léia CR Silva
- Laboratory of Dermatology & Immunodeficiencies, Dermatology Division, Clinics Hospital, São Paulo, Brazil
| | - Luciena CM Ortigosa
- Laboratory of Dermatology & Immunodeficiencies, Dermatology Division, Clinics Hospital, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Mycology, Tropical Medicine Institute, University of São Paulo Medical School, São Paulo, Brazil: R Dr Eneas de Carvalho Aguiar 470, Instituto de Medicina Tropical (IMT), Cerqueira Cesar, São Paulo, SP, 05403 903, Brazil
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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