Development of morphea during Nivolumab treatment

Abstract

agents with anti-tumour necrosis factor (TNF) agents and IVIG as 2 nd and 3 rd line steroid-sparing agents, respectively. Other agents with low toxicity, for example doxycycline, topical corticosteroids and topical 0.1% tacrolimus, were frequently used as additional agents.Systemic corticosteroid dosage was weaned as rapidly as possible to minimise side effects. Mycophenolate was used more frequently than cyclosporin based mainly on the side-effect profile (Table 3). Mycophenolate sodium has more recently been used in preference to mycophenolate mofetil (MMF) due to lower incidence of gastrointestinal side effects. A higher incidence of troublesome side effects occurred with cyclosporin. 7,8 Mycophenolate and lower doses of cyclosporin were sometimes used simultaneously to reduce side effects. Notably, however 3 patients developed bowel perforation while on MMF highlighting the importance of ceasing therapy if gastrointestinal side effects develop. Therapy with anti-TNF agents were added if control could not be achieved. IVIG was used with good effect if activity still persisted despite the addition of anti-TNF treatment. It was also used if further immunosuppressive therapy was unsuitable due to risks of infection or malignancy.Oral corticosteroid therapy is a mainstay of therapy. 9 Long-term cumulative side effects represent one of the major challenges of PG management. The monitoring for steroid-induced side effects was reviewed including osteoporosis, steroid-induced diabetes, opportunistic infection and gastrointestinal side effects. The development of standardised evidence-based protocols for the management of these critical issues would assist clinicians in minimising the consequences of long-term corticosteroid therapy and high dose immunosuppression in PG patients.The goal of this study was to undertake a detailed analysis of the largest cohort of patients in an Australian population and highlight issues relating to demographics, diagnosis and management.