Assuntos
Citocinas/sangue , Etanercepte/uso terapêutico , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Psoríase/sangue , Psoríase/tratamento farmacológico , Administração Oral , Adulto , Idoso , Citocinas/metabolismo , Etanercepte/administração & dosagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Subcutâneas , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/metabolismo , Índice de Gravidade de Doença , Linfócitos T Auxiliares-Indutores/metabolismo , Linfócitos T Reguladores/metabolismo , Adulto JovemAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Etanercepte/efeitos adversos , Síndromes Mielodisplásicas/induzido quimicamente , Síndromes Mielodisplásicas/diagnóstico , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Esquema de Medicação , Etanercepte/administração & dosagem , Humanos , MasculinoRESUMO
Patients with psoriasis are at an increased risk of developing liver disease due to various factors. The existing data regarding the treatment of psoriasis patients with associated liver cirrhosis is limited. We report four patients of psoriasis with liver cirrhosis who were treated with TNF-alpha inhibitors for a mean duration of 35.4 months. Two patients were treated with etanercept, one with adalimumab and one was treated with both infliximab and etanercept. Three patients tolerated the treatment well without any deterioration of liver disease whereas one died of progressive liver disease. Although large-scale, controlled studies are needed, this case series provides insights regarding the long-term safety of TNF-alpha inhibitors in patients with psoriasis and liver cirrhosis.
Assuntos
Cirrose Hepática/diagnóstico , Cirrose Hepática/tratamento farmacológico , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Etanercepte/administração & dosagem , Feminino , Humanos , Infliximab/administração & dosagem , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Psoríase/complicações , Resultado do TratamentoRESUMO
Erythema nodosum leprosum (ENL) is a common complication of lepromatous leprosy. Some patients unresponsive to conventional, first-line therapeutics develop recurrent, recalcitrant ENL. Here, we report a case of severe refractory ENL that was successfully treated with Etanercept. Biologics may be considered as therapeutic alternatives in management of severe, recalcitrant ENL.
Assuntos
Eritema Nodoso/tratamento farmacológico , Etanercepte/administração & dosagem , Hanseníase/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Eritema Nodoso/etiologia , Eritema Nodoso/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Anti-tumor necrosis factor (TNFα) agents have acquired a prominent place in the treatment options for inflammatory disorders. Among the side effects of these agents are the so-called paradoxical reactions which have increasingly been reported in recent years. A review of literature was carried out using Medline (PubMed) database from January 2010 to December 2014 to collect all published articles on cases of anti-TNFα-induced psoriasis and psoriatic arthritis. Published articles were identified, reviewed and the relevant data extracted. A total of 22 studies (46 patients) fulfilled the inclusion criteria and were selected for analysis. Of the 46 patients, 45 (97.8%) developed psoriasis and 1 (2.1%) psoriatic arthritis. The mean age of patients was 47 years; three (6.5%) patients had a past history of psoriasis. Infliximab caused cutaneous reactions in the most number, 26 (56.5%) cases. Thirty seven (80.4%). patients developed primary plaque-type psoriasis. Women accounted for 86.9% of patients. There was complete resolution of psoriasis in 12 (26%) patients despite differences in the therapeutic approach. Cessation of the incriminated drug led to resolution of cutaneous lesions in 5 (10.8%), switching to another TNFα antagonist led to resolution in 6 (13%) and one (2.1%) patient improved despite continuation of the drug. As for the lone case of psoriatic arthritis, drug withdrawal did not result in improvement; only switching to another anti-TNFα agent helped. Since our sample was small, it was not adequately powered to draw any firm conclusions. However, in this analysis, we found that paradoxical reactions occurred predominantly in adult women, there were only isolated cases with a personal history of psoriasis, infliximab was responsible for most cases of these reactions and the most prevalent form was plaque-type psoriasis. The decision whether to continue or discontinue the triggering anti-TNFα agent should be individualized as results are highly variable.