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Various toxicities: 41 case reports

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Bonnet N, et al. Cutaneous events during anti-TNF alpha therapy: A prospective observational study of 41 cases. Annales de Dermatologie et de Venereologie 137: 12-20, No. 1, Jan 2010. Available from: URL: http://dx.doi.org/10.1016/ j.annder.2009.12.003 [French; summarised from a translation] 803010724 France

Twenty women and 21 men experienced cutaneous events during treatment with adalimumab, etanercept and/ or infliximab [dosages not stated; outcomes not stated in some cases] for arthritic, dermatological and gastroenterological disorders. The patients were identified as part of a prospective observational study. The ages of the 41 patients ranged from 18 to 76 years (average 48.7 years). The anti-TNF-α agent implicated was infliximab in 18 patients, etanercept in 13 and adalimumab in 12. The indication was rheumatoid polyarthritis, ankylosing spondylarthritis or psoriatic arthritis in 13, 11 and 7 cases, respectively, psoriasis in 3 cases, Crohn’s disease (CD) in 4 and haemorrhagic rectocolitis in 3 cases. Fifteen patients (10 women) developed psoriasiform eruptions and/or palmoplantar pustulosis during treatment for rheumatoid polyarthritis, ankylosing spondylarthritis or psoriatic arthritis. Infliximab was implicated in 6 cases, adalimumab in 5 and etanercept in 5 cases. Time to onset varied greatly from 2 weeks to 7 years; average onset times were 33, 20.3 and 4.2 months for infliximab, etanercept and adalimumab, respectively. Some patients had received more than one anti-tumour necrosis factor (TNF)-α agent prior to reaction onset. Anti-TNF-α therapy was discontinued in 8 patients, leading to resolution of skin lesions in 3 patients and improvement in 2 patients; therapy was continued in 6 patients with concurrent dermocorticoids, while in the remaining case, changing the time between injections led to improvement of skin lesions. According to the official French imputability method, the drug imputability was classified as likely, plausible and uncertain in 1, 6 and 8 cases, respectively. Three men aged 37, 21 and 72 years, respectively, developed eczematiform lesions after receiving infliximab (first two men) or etanercept for 1 year, 1 month and 2 months, respectively. The drug imputability was classified as uncertain in the first 2 cases and plausible in the latter. Biopsies of skin eruptions in a 28-year-old woman and two men aged 28 and 37 years were consistent with erythematous lupus. All three were receiving infliximab and symptom onset occurred after 2 weeks’ therapy for CD, after 3 week’s therapy for CD and after 18 months’ therapy for severe psoriasis, respectively. Anti-TNF-α therapy was discontinued in the woman and older man and continued in the younger man. The drug imputability was classified as uncertain for the men and plausible for the woman. Infections developed in 3 men and 3 women aged 34–61 years. The implicated drugs were etanercept (3 cases) and adalimumab. Outcomes were not stated in all 6 cases. In the one case where causality was assessed