Drug-induced Bullous Pemphigoid and Lupus Erythematosus Occurring under Anti-TNF-α and IL-6 Therapy in a Patient with Rheumatoid Arthritis

Yoshikawa, Noritada; Matsubara, Erika; Yamamoto, Motohisa; Yamazaki, Hiroki; Uehara, Masaaki; Kamata, Masahiro; Tanaka, Hirotoshi

doi:10.2169/internalmedicine.4646-20

Cited by 9 publications

(6 citation statements)

References 48 publications

(54 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For some therapeutic classes, such as PPIs, thiazide diuretics, anti-TNFα, and chemotherapy agents, class effects have been reported 59 ; thus, it may be necessary to contraindicate drugs of the same drug class 7 . There are also case reports of the disease recurrence after switching pharmacological classes, which reinforces the idea that there may be some genetic susceptibility for Di-LE 60 .…”

Section: Reversibility and Treatment Of Di-lesupporting

confidence: 63%

Drug-induced lupus erythematosus

Gouveia,

Gonçalo

2023

PJDV

View full text Add to dashboard Cite

Drug-induced lupus erythematosus is an autoimmune disease with unexpected onset after treatment with certain drugs. Clinically, this disease is very similar to idiopathic lupus erythematosus, although its manifestations are typically milder. In addition, the laboratory and histological changes of the induced forms are also not significantly different from the idiopathic condition, sometimes making the diagnosis of the drug-induced form a challenge for clinicians. This entity has been gaining relevance in the clinical setting and the number of drugs associated with it has been increasing, mainly due to the emergence of new biological therapies with a strong causal link with drug-induced lupus, such as tumor necrosis factor-alpha inhibitors. However, there are still no universally accepted diagnostic criteria to identify this disease, and information about its pathophysiology is still somewhat scarce, making it difficult to predict the most likely culprit drugs before there are enough reports to establish a strong link. In addition, although some risk factors have shown susceptibility for certain individuals, they are not yet fully understood. Given the possibility of disease reversal by the withdrawal of the offending drug, it is extremely important to be aware of the possible implication of a drug in the pathogenesis of this disease, and for clinicians who approach patients with lupus manifestations, particularly cutaneous manifestations, it is mandatory to look for the onset of new drugs used by the patient. This review will systematize the current knowledge about this drug-induced lupus, in terms of pathophysiology, clinical, histopathological, and laboratory manifestations, diagnosis, and treatment, as well as the most commonly implicated drugs.

show abstract

Section: Reversibility and Treatment Of Di-lesupporting

confidence: 63%

Drug-induced lupus erythematosus

Gouveia,

Gonçalo

2023

PJDV

View full text Add to dashboard Cite

show abstract

“…The time interval between drug use and the occurrence of complications varied from 2 weeks to 3 years. 43 Regardless of the type of disease, it is recommended to discontinue TNF-α inhibitors and start specific treatment such as topical or systemic corticosteroids. The addition of other immunosuppressive drugs such as DMARDs may help lesions heal more rapidly.…”

Section: Autoimmune Bullous Diseasesmentioning

confidence: 99%

Paradoxical and bimodal immune‐mediated dermatological side effects of TNF‐α inhibitors: A comprehensive review

Behrangi,

Moodi,

Jafarzadeh

et al. 2024

Skin Research and Technology

View full text Add to dashboard Cite

IntroductionDue to the increasing prevalence of immune‐mediated diseases such as psoriasis, lichen planus, rheumatoid arthritis and inflammatory bowel disease, dermatologists have turned to new biologic drugs known as DMARDs (disease‐modifying anti‐rheumatic drugs) in recent years.Areas CoveredIn this study, we evaluate the immune‐mediated dermatological side effects of DMARDS by reviewing and analyzing previous peer‐reviewed research on the effects of TNF‐α inhibitors in the treatment of skin diseases, as well as adverse effects of these drugs and some of the main causes of these effects.Expert OpinionDMARDs are very effective in improving control of the above diseases. TNF‐α inhibitors are an important group of DMARDs that are widely used. The paradoxical adverse events (PAEs) associated with the use of TNF‐α inhibitors are divided into three categories: true paradoxical, borderline paradoxical, and non‐paradoxical. True PAEs include conditions for which TNF‐α inhibitors are approved for treatment. Borderline PAEs are considered to occur with this class of drugs for which there is no definite approval but for which there is sufficient evidence. Although these events are rare, early recognition of the accused drug and appropriate decision‐making may prevent progression of complications and irreversible side effects.

show abstract

“…A reoccurrence in one patient was due to reintroducing adalimumab, and symptoms were relieved after ceasing the drug ( 15 ). In one case, the initiation of tocilizumab for rheumatoid arthritis induced a recurrence of BP, and switching from topical corticosteroids to oral achieved remission of the disease successfully ( 16 ).…”

Section: Tumor Necrosis Factor-α Blockersmentioning

confidence: 99%

Paradoxical phenomena of bullous pemphigoid induced and treated by identical biologics

2023

View full text Add to dashboard Cite

ObjectiveThis study aimed to investigate the clinical features of biologics-induced bullous pemphigoid (BP) and the therapeutic effects of those agents for BP, exploring the underlying pathophysiological mechanisms.MethodsWe searched PubMed, Web of Science, and Elsevier for studies involving pemphigoid patients treated with or induced by identical biologics published in English from January 2009 to April 2022.ResultsSeventeen cases of drug-induced BP associated with anti-tumor necrosis factor (aTNF)-α therapies, one with interleukin (IL)-17 inhibitors, and seven with IL-12/IL-23 or IL-23 inhibitors were enrolled. Time to cutaneous toxicity varied among different types of agents, and the characteristics of clinical examinations were similar to idiopathic BP. Discontinuation of the culprit drugs and initiation of topical or systemic corticosteroids were adequate in most cases. Several monoclonal antibodies above have also been reported for the treatment of refractory or recurrent BP, especially concurrent with psoriasis.ConclusionBiologics for immune-related diseases, including TNF-α, IL-17, and IL-12/IL-23 or IL-23 inhibitors, can both induce and treat BP, which might be associated with a helper T cells Th1/Th2 imbalance, complicated inflammatory networks, and a specific individual microenvironment, suggestive of a new perspective on the therapeutic algorithms of BP. There have been numerous reports about biologics inducing or treating BP. We have taken note of this phenomenon and focused on biologics with both pathogenetic and therapeutic effects on BP. Our review summarized the clinical characteristics of associated cases, trying to figure out the underlying mechanisms of this paradoxical phenomenon and to provide an integrated perspective and new therapeutic alternatives for BP.

show abstract

Drug-induced Bullous Pemphigoid and Lupus Erythematosus Occurring under Anti-TNF-α and IL-6 Therapy in a Patient with Rheumatoid Arthritis

Cited by 9 publications

References 48 publications

Drug-induced lupus erythematosus

Drug-induced lupus erythematosus

Paradoxical and bimodal immune‐mediated dermatological side effects of TNF‐α inhibitors: A comprehensive review

Paradoxical phenomena of bullous pemphigoid induced and treated by identical biologics

Contact Info

Product

Resources

About