Erythema nodosum and glatiramer acetate treatment in relapsing-remitting multiple sclerosis

Abstract

Glatiramer acetate (GA), a well tolerated immunomodulatory treatment for relapsing-remitting multiple sclerosis (RR-MS), consists of a 4-amino acid polymer that mimics the myelin basic protein (MBP). We report the first case of biopsy-proven erythema nodosum (EN) in a patient presenting RR-MS under GA treatment. Comprehensive exams were negative in the search of the etiology of EN, which spontaneously resolved despite treatment continuation. GA treatment is known to generate reactive polyclonal antibodies that can cross-react with myelin epitopes, like MBP. These antibodies may also be implicated in allergenic reactions and auto-immune adverse events, such as anaphylactic shock, lymphadenopathy, livedo-like dermatitis, or lymphocytic infiltration. EN is an unspecific skin reaction occurring in several disorders and induced by many treatments. As EN can result from a polyclonal antibody response or type I hypersensitivity mechanisms, we hypothesize that GA treatment could be responsible for the occurrence of EN.

Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review

“…[93][94][95] Cutaneous events with an inflammatory pathogenesis that were described only once in association with DMTs include dermatomyositis, erythema nodosum, scleromyxedema, lupus erythematosus profundus, vitiligo, and Jessner-Kanof benign lymphocytic infiltrate. [96][97][98][99][100][101] …”

Cutaneous adverse events related to glatiramer acetate injection (copolymer‐1, Copaxone®)

“…Secretion of neurotrophic factors with potential neuroprotective effects was shown 7 . Single case report of erythema nodosum, 6 Jessner–Kanoff infiltration, 8 urticarial vasculitis, 9 and primary cutaneous CD30 T‐cell lymphoma 10 have been reported. These complications may be consequence of switching the T‐cell response from Th1 to Th2.…”

“…Cases of type I hypersensitivity reaction (anaphylactic shock) are rare 5 . Urticaria and pruritus have also been reported according to the French national data bank of pharmacovigilance 6 …”

Adherence to glatiramer acetate treatment for multiple sclerosis: the Brazilian experience

“…Severe skin reactions to GA injections have recently been reported in some patients (Frohman et al 2004). Although infrequent, such skin reactions (including lipoatrophy, necrosis, and erythema nodosum) are severe enough to require discontinuation of GA treatment (Frohman et al 2004;Thouvenot et al 2007).…”