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4.
Indian J Dermatol Venereol Leprol ; 87(2): 227-234, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31293276

RESUMO

BACKGROUND: Patients with reactive arthritis frequently present to dermatologists. However, there is paucity of information regarding its clinical aspects and management in dermatological literature. OBJECTIVE: To review the clinical features and management of patients with chronic reactive arthritis admitted to the dermatology department of a teaching hospital. METHODS: This was a retrospective analysis of patients with reactive arthritis admitted to the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India from January 2016 to February 2018. RESULTS: There were 12 males (disease duration 9-180 months). Biologics were used in 9 (75%) patients on 16 different occasions, the most frequent being infliximab (n = 10 times), followed by adalimumab (n = 3), etanercept, secukinumab and itolizumab (n = 1 each), in combination with other systemic agents. Response rate with treatment regimens including biologics (69% responders, 31% partial responders) was statistically significantly better than those without biologics (27% responders, 46% partial responders, 27% nonresponders; P = 0.036), using a composite measure assessing improvement in skin and joint symptoms. Biologics were discontinued on 50% of the occasions, after a median of 3.5 months (range 1.5-7.5 months) because of satisfactory response (n = 4), therapeutic fatigue (n = 3) or adverse event (n = 1). After biologic discontinuation, the response was sustained for a median of 5 months (range 3-6 months) before disease exacerbation. The number of treatment switches increased with the follow-up duration (median three switches per patient, range 1-8). The median follow-up duration was 10.5 months (range 4-76 months). CONCLUSION: Biologics produce rapid improvement in skin and joint symptoms in chronic reactive arthritis, but the response is not long-lasting. Patients with chronic reactive arthritis have a waxing and waning course despite regular treatment. LIMITATIONS: The limitations are retrospective design, small sample size and lack of a validated outcome measure.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reativa/tratamento farmacológico , Adalimumab/uso terapêutico , Adolescente , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Doença Crônica , Etanercepte/uso terapêutico , Humanos , Infliximab/uso terapêutico , Masculino , Estudos Retrospectivos , Adulto Jovem
5.
Am J Trop Med Hyg ; 102(5): 1131-1136, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32157993

RESUMO

Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNF-α inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.


Assuntos
Produtos Biológicos/uso terapêutico , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Adulto , Humanos , Infliximab/uso terapêutico , Masculino , Fator de Necrose Tumoral alfa/antagonistas & inibidores
6.
Artigo em Inglês | MEDLINE | ID: mdl-31719235

RESUMO

Anti-tumor necrosis factor-alpha (TNF-α) immunotherapy has revolutionized the treatment of inflammatory diseases, such as psoriasis and psoriatic arthritis. However, a major concern is that patients receiving this therapy have an increased risk of infection, particularly of reactivation of latent tuberculosis (TB). There were an estimated 10.4 million new cases of tuberculosis in 2016, worldwide, and India has one of the largest TB case burden with an estimated incidence of 2.79 million cases of TB in the same year. Anti-TNF agents like etanercept and infliximab are available in India approved for psoriasis and psoriatic arthritis. But long-term use of these agents possesses a risk of reactivation of latent TB. In this review article, we assessed the risk of TB with anti-TNF therapy especially in patients with psoriasis and psoriatic arthritis in India. At the end of the article, we have also suggested a recommendation for screening of latent tuberculosis and its management, before starting anti-TNF-α therapy.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Etanercepte/uso terapêutico , Infliximab/uso terapêutico , Tuberculose Latente/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Humanos , Índia
7.
Artigo em Inglês | MEDLINE | ID: mdl-27451931

RESUMO

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 Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-26728803

RESUMO

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.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Psoríase/induzido quimicamente , Fator de Necrose Tumoral alfa/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/efeitos adversos , Adulto , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Artrite Psoriásica/induzido quimicamente , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/fisiopatologia , Etanercepte/administração & dosagem , Etanercepte/efeitos adversos , Feminino , Seguimentos , Humanos , Incidência , Infliximab/administração & dosagem , Infliximab/efeitos adversos , Masculino , Pessoa de Meia-Idade , Psoríase/epidemiologia , Psoríase/fisiopatologia
10.
An Bras Dermatol ; 88(6 Suppl 1): 23-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24346871

RESUMO

Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Fatores Biológicos/efeitos adversos , Hanseníase/induzido quimicamente , Artrite Reumatoide/tratamento farmacológico , Biópsia , Humanos , Infliximab , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Fator de Necrose Tumoral alfa/antagonistas & inibidores
11.
Indian J Dermatol Venereol Leprol ; 79 Suppl 7: S25-34, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23974692

RESUMO

Moderate to severe psoriasis often needs to be addressed with standard disease modifying therapies such as methotrexate, cyclosporine, acitretin or ultraviolet radiation, which have their potential benefits and limitations. The tumor necrosis factor-alpha (TNF-α) is elevated in psoriatic plaques compared to non lesional skin as well as in the plasma of patients with moderate to severe psoriasis. Infliximab, a TNF-α blocker, has been recommended for the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to these therapies or who cannot tolerate them. Its specific action on the bound and membrane forms of the pro-inflammatory cytokine TNF-α has made it the molecule of choice for obtaining quicker and longer remission in recalcitrant cases. However, the widespread use of infliximab in the Indian subcontinent is limited by its cost. This article reviews the international guidelines for use of infliximab, its dosage patterns, and efficacy in chronic plaque psoriasis, nail psoriasis, erythrodermic psoriasis, and pustular psoriasis as well as Indian experience.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Ásia , Fármacos Dermatológicos/administração & dosagem , Progressão da Doença , Guias como Assunto , Humanos , Infliximab , Fator de Necrose Tumoral alfa/antagonistas & inibidores
12.
Indian J Dermatol Venereol Leprol ; 79 Suppl 7: S35-46, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23974693

RESUMO

As elevated levels of tumor necrosis factor-alpha (TNF-α) are associated with disease severity in psoriasis and psoriatic arthritis, TNF-α antagonists are being used to treat moderate to severe disease in patients who have contraindications, fail to respond or develop side effects to conventional systemic therapies. It is of utmost importance to be well versed with the possible adverse effects and contraindications of TNF-α antagonists so that they can be used effectively and safely. Many of their adverse effects have been well studied in patients of rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) and may not be completely applicable in psoriasis. This is because patients with RA and IBD are on multiple immunosuppressants while those with psoriasis are mostly receiving single systemic therapy and often have comorbidities that distinguish them from those with RA or IBD. Also, some of the side effects are still controversial and debated. Long-term prospective randomized controlled studies are needed to better understand the associated risk in patients of psoriasis. Baseline screening and periodic monitoring during treatment can reduce and help in early identification and appropriate management of the adverse outcomes. This article reviews the side effects known to be associated with TNF-α antagonists, their pathomechanisms and management guidelines. Some of the common side effects include infusion and injection site reactions, infections particularly reactivation of tuberculosis, autoantibody formation and drug induced lupus erythematosus, liver function abnormalities, hematological, and solid organ malignancies.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hipersensibilidade a Drogas/terapia , Tuberculose Latente/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Anormalidades Induzidas por Medicamentos/etiologia , Adalimumab , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Etanercepte , Humanos , Imunoglobulina G/efeitos adversos , Infliximab , Injeções/efeitos adversos , Tuberculose Latente/tratamento farmacológico , Fígado/efeitos dos fármacos , Fígado/fisiopatologia , Neoplasias/induzido quimicamente , Doenças do Sistema Nervoso/induzido quimicamente , Psoríase/induzido quimicamente , Receptores do Fator de Necrose Tumoral , Trombocitopenia/induzido quimicamente , Tromboembolia/induzido quimicamente
14.
Arthritis Res Ther ; 14(3): R147, 2012 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-22709461

RESUMO

INTRODUCTION: The usefulness of interferon-gamma (IFN-γ) release assays for tuberculosis screening before tumor necrosis factor-alpha (TNF-α) antagonists and for monitoring during treatment is a contraversial issue. The aims of this study were to determine whether TNF-α antagonists affect the results of the Quantiferon-TB Gold in-tube assay (QTF); to assess how QTF performs in comparison with the tuberculin skin test (TST) in rheumatoid arthritis (RA) patients who are about to start treatment with TNF-α antagonists, RA patients who are not candidates for treatment with TNF-α antagonists, rheumatology patients with confirmed current or past tuberculosis infection, and healthy controls, and to determine the specificity of the QTF test to differentiate leprosy patients, another group of patients infected with mycobacteria. METHODS: The 38 RA patients who were prescribed TNF-α antagonists, 40 RA patients who were not considered for TNF-α antagonist use, 30 rheumatology patients with a history or new diagnosis of tuberculosis, 23 leprosy patients, and 41 healthy controls were studied. QTF and TST were done on the same day, and both were repeated after a mean of 3.6 ± 0.2 months in patients who used TNF-α antagonists. RESULTS: Treatment with TNF-α antagonists did not cause a significant change in the QTF or TST positivity rate (34% versus 42%; P = 0.64; and 24% versus 37%; P = 0.22). Patients with leprosy had a trend for a higher mean IFN-γ level (7.3 ± 8.0) and QTF positivity (61%) than did the other groups; however, the difference was not significant (P = 0.09 and P = 0.43). CONCLUSIONS: Treatment with TNF-α antagonists does not seem to affect the QTF test to an appreciable degree. The higher IFN-γ levels in leprosy patients deserves further attention.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Testes de Liberação de Interferon-gama , Tuberculose Latente/diagnóstico , Teste Tuberculínico , Adalimumab , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Etanercepte , Feminino , Humanos , Imunoglobulina G/efeitos adversos , Infliximab , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral
16.
J Clin Rheumatol ; 17(5): 269-71, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21778902

RESUMO

Tumor necrosis factor α antagonists are proven to be effective for the treatment of chronic inflammatory conditions, such as psoriasis. A major concern for patients is the risk of acquiring granulomatous infectious diseases caused by the immunosuppressive effects of the drugs. We report a 60-year-old man with psoriasis who underwent infliximab treatment for 2 years and developed secondary leprosy, presenting extensive erythematous and infiltrated plaques on the trunk and limbs with loss of sensitivity (thermal, pain and tactile). The skin lesion biopsy showed perivascular epithelioid granulomas, nodular dermal aggregates of foamy macrophages and bundles of acid-fast bacilli. The clinical picture associated with histopathologic evaluation suggested borderline lepromatous leprosy. Before infliximab treatment, the patient had a positive tuberculin skin test and underwent chemoprophylaxis treatment for latent tuberculosis. Although the tuberculin reactivity suggests a strong correlation with a latent Mycobacterium tuberculosis infection, the possibility of infections by other mycobacteria, such as Mycobacterium leprae, should not be discarded.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/microbiologia , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Antituberculosos/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Infliximab , Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae , Mycobacterium tuberculosis , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia
17.
Clin Rheumatol ; 28(5): 615-7, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19259757

RESUMO

The use of tumor necrosis factor alpha as a treatment for chronic inflammatory conditions has been shown to be associated with an increased risk of developing infections, especially Mycobacterium tuberculosis, atypical mycobacteria, and other microorganisms. We report the case of a 58-year-old man with ankylosing spondylitis, receiving infliximab treatment, who presented with multiple plaques on the face, chest, and extremities, a thickened, tender ulnar nerve, and severe neuritis of the feet. The results of a biopsy of these lesions revealed histopathological features of lepromatous Hansen disease. The use of anti-tumor necrosis factor biologic agent on this patient may have resulted in either a new infection or reactivation of a latent infection of Mycobacterium leprae.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Hanseníase/complicações , Hanseníase/diagnóstico , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Biópsia , Humanos , Infliximab , Hanseníase/etiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/metabolismo , Espondilite Anquilosante/microbiologia , Resultado do Tratamento
19.
Clin Infect Dis ; 43(2): e19-22, 2006 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-16779736

RESUMO

Humanized monoclonal antibodies to tumor necrosis factor- alpha are valuable for the treatment of rheumatologic conditions, but they have been associated with the development of serious infections. We report the first 2 cases of leprosy developing after treatment with infliximab. After discontinuation of infliximab, both patients developed type 1 ("reversal") leprosy reactions.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite/tratamento farmacológico , Hanseníase Dimorfa/etiologia , Idoso , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/imunologia , Antirreumáticos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Infliximab , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/induzido quimicamente , Hanseníase Dimorfa/microbiologia , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/antagonistas & inibidores
20.
Artigo em Inglês | MEDLINE | ID: mdl-16707820

RESUMO

BACKGROUND: Insights into the pathogenesis of psoriasis have provided opportunities to target key steps in the disease process. Tumor necrosis factor-alpha (TNF- alpha) being crucial to the pathogenesis of psoriasis, monoclonal antibodies against this cytokine have proved useful in its treatment. AIM: To study the efficacy of chimeric monoclonal antibody to TNF- alpha (infliximab) in Indian patients with recalcitrant psoriasis vulgaris. MATERIALS AND METHODS: Three patients with recalcitrant psoriasis vulgaris were studied. Baseline haemogram, biochemical parameters, chest radiograph and Mantoux skin test were performed. A loading dose regimen of 5 mg/kg infliximab was administered at weeks 0, 2 and 6. PASI assessment, adverse drug event monitoring and laboratory assessments were carried out at 2-week intervals until week 10. Patients were followed up until week 22 for relapse. RESULTS: Infliximab was well tolerated. The mean PASI was 25.4 at presentation and declined to 5.5 at 10 weeks. PASI 75 was attained at a mean of 9.6 weeks. Relapse occurred at a mean of 18.6 weeks after the first infusion. CONCLUSIONS: This study on Indian patients brings out the importance of cytokine-based therapies in psoriasis. Indigenous production could make these therapies a viable therapeutic option for psoriasis patients in the near future.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Anticorpos Monoclonais/efeitos adversos , Humanos , Infliximab , Pessoa de Meia-Idade , Projetos Piloto , Psoríase/patologia
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