Anti-TNFα treatment for recalcitrant ulcerative necrobiosis lipoidica diabeticorum: A case report and review of the literature

Basoulis, Dimitrios; Fragiadaki, Kalliopi; Tentolouris, Nicholas; Sfikakis, Petros P.; Kokkinos, Alexander

doi:10.1016/j.metabol.2015.12.014

Cited by 21 publications

(22 citation statements)

References 16 publications

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“…Die Off‐Label‐Anwendung erfordert jedoch eine enge Indikationsstellung und Patientenaufklärung. Die bisher publizierten Fallberichte (vorwiegend TNFα‐Inhibitoren ) deuten aber auf ein gutes Ansprechen bei gleichzeitig guter Verträglichkeit hin, auch wenn RCT hierzu fehlen. Geringe Patientenzahlen, schwer vergleichbare Studiendesigns und fehlende Abgrenzung zwischen ulzerierten und nichtulzerierten Fällen erschweren die Studienanalyse .…”

Section: Necrobiosis Lipoidicaunclassified

Systemische Therapien des Ulcus cruris

Dissemond

Erfurt‐Berge

Goerge

et al. 2018

J Deutsche Derma Gesell

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ZusammenfassungFür eine erfolgreiche Behandlung von Patienten mit Ulcus cruris ist es essentiell, die zugrundeliegende Ätiologie zu klären und, wenn möglich, eine kausale Therapie einzuleiten. Begleitend ist die an den Phasen der Wundheilung orientierte Wundbehandlung, meist in Verbindung mit einer Kompressionstherapie, die Therapie der Wahl. Der Stellenwert der systemischen Therapien wird in Abhängigkeit der zugrundeliegenden Genese sehr unterschiedlich und oft kontrovers beurteilt. In diesem Übersichtsartikel werden die aktuellen Aspekte der systemischen medikamentösen Therapien für Patienten mit Ulcus cruris bei den häufigen Genesen chronische venö-se Insuffizienz, periphere arterielle Verschlusskrankheit, Livedovaskulopathie, Vaskulitis, Necrobiosis lipoidica, Calciphylaxie und Pyoderma gangraenosum differenziert vorgestellt und kritisch diskutiert.Zusammenfassend kann festgestellt werden, dass es sich bei vielen der hier vorgestellten Therapien um einen Off-Label-Use handelt. Bei den häufiger vorkommenden Wundarten wie beispielsweise Ulcus cruris venosum, mixtum und arteriosum sind Medikamente für die Therapie zwar hoffnungsvolle Optionen, bisher aber in der Regel kein Behandlungsstandard. Im Gegensatz hierzu haben systemische Therapien bei den anderen hier vorgestellten Krankheitsbildern eine meist zentral wichtige Bedeutung. Es sind in erster Linie immunmodulierende und rheologisch wirksame Medikamente, die eingesetzt werden, um die Wundheilung zu beschleunigen. SummarySuccessful management of patients with leg ulcers requires identification of the underlying etiology, with subsequent initiation of causal treatment, if feasible. Supplementary measures of first choice include stage-adjusted wound treatment, usually combined with compression therapy. The significance of systemic drugs has been the subject of controversial debate, depending on the underlying cause of the condition. The present review article is therefore meant to highlight current aspects of systemic drug therapies for the treatment of leg ulcers associated with chronic venous insufficiency, peripheral arterial disease, livedoid vasculopathy, vasculitis, necrobiosis lipoidica, calciphylaxis and pyoderma gangrenosum.In summary, the majority of therapeutic options presented herein are used off-label. While systemic drugs are promising options for the more common types of wounds such as venous, mixed or arterial leg ulcers, they do not represent the

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Section: Necrobiosis Lipoidicaunclassified

Systemische Therapien des Ulcus cruris

Dissemond

Erfurt‐Berge

Goerge

et al. 2018

J Deutsche Derma Gesell

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“…Medications most commonly seen and discussed in the literature include topical calcineurin inhibitors, pentoxifylline, etanercept, adalimumab, and infliximab 3, 4, 5, 6, 7, 8. Our patient presented with ulcerative NL despite her systemic treatment for RA, which included 2 of the recommended treatment options for NL: hydroxychloroquine and etanercept.…”

Section: Discussionmentioning

confidence: 95%

“…NL typically develops in the third to fourth decade of life with a slight female predominance 1 . In about one-third of cases, ulceration can develop as a complication, which poses unique treatment challenges to providers, as it is often recalcitrant to treatment 2, 3. The literature suggests that anti–tumor necrosis factor-α medications represent a promising therapeutic strategy for ulcerative disease 3, 4.…”

Section: Introductionmentioning

confidence: 99%

“…In about one-third of cases, ulceration can develop as a complication, which poses unique treatment challenges to providers, as it is often recalcitrant to treatment 2, 3. The literature suggests that anti–tumor necrosis factor-α medications represent a promising therapeutic strategy for ulcerative disease 3, 4. Here we present a case of ulcerative NL that developed in the setting of etanercept and hydroxychloroquine treatment, and subsequently re-epithelialized with aggressive local treatment and discontinuation of etanercept.…”

Section: Introductionmentioning

confidence: 99%

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Ulcerative necrobiosis lipoidica in the setting of anti–tumor necrosis factor-α and hydroxychloroquine treatment for rheumatoid arthritis

2017

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“…However, given that their use is off‐label, it requires that the indication be chosen with care and that patients give informed consent. Nevertheless, the case reports published to date (primarily TNFα inhibitors ) suggest an adequate response along with good tolerance, even though RCTs are still lacking. The evaluation of study data is complicated by low patient numbers, difficult‐to‐compare study designs, and lack of distinction between cases with and without ulcerations .…”

Section: Necrobiosis Lipoidicamentioning

confidence: 99%

Systemic therapies for leg ulcers

Dissemond

Erfurt‐Berge

Goerge³

et al. 2018

J Deutsche Derma Gesell

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Successful management of patients with leg ulcers requires identification of the underlying etiology, with subsequent initiation of causal treatment, if feasible. Supplementary measures of first choice include stage-adjusted wound treatment, usually combined with compression therapy. The significance of systemic drugs has been the subject of controversial debate, depending on the underlying cause of the condition. The present review article is therefore meant to highlight current aspects of systemic drug therapies for the treatment of leg ulcers associated with chronic venous insufficiency, peripheral arterial disease, livedoid vasculopathy, vasculitis, necrobiosis lipoidica, calciphylaxis and pyoderma gangrenosum. In summary, the majority of therapeutic options presented herein are used off-label. While systemic drugs are promising options for the more common types of wounds such as venous, mixed or arterial leg ulcers, they do not represent the current standard of treatment. By contrast, systemic agents play a key role in the management of many of the other disorders presented herein. These agents primarily include immunomodulatory and rheological drugs used to expedite wound healing.

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Anti-TNFα treatment for recalcitrant ulcerative necrobiosis lipoidica diabeticorum: A case report and review of the literature

Cited by 21 publications

References 16 publications

Systemische Therapien des Ulcus cruris

Systemische Therapien des Ulcus cruris

Ulcerative necrobiosis lipoidica in the setting of anti–tumor necrosis factor-α and hydroxychloroquine treatment for rheumatoid arthritis

Systemic therapies for leg ulcers

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