Immunological changes in psoriasis patients under long-term treatment with fumaric acid esters: risk of Kaposi sarcoma occurrence?

Philipp, Sandra; Kokolakis, Georgios; Hund, Martina; Witte, Ellen; Witte, Katrin; Kunz, Stefanie; Roewert, Hans Joachim; Sterry, Wolfram; Sabat, Robert

doi:10.1684/ejd.2013.2014

Cited by 21 publications

(34 citation statements)

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“…Affected patients were lymphopenic and had been treated with fumarates for years. Fatal West Nile encephalitis, disseminated varicella zoster, and Kaposi sarcoma have also been associated with fumarates (10-12). …”

Section: Introductionmentioning

confidence: 99%

Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients

et al. 2015

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Background Dimethyl fumarate (DMF) alters the phenotype of circulating immune cells and causes lymphopenia in a subpopulation of treated MS patients. Objective To phenotypically characterize circulating leukocytes in DMF-treated MS patients. Methods Cross-sectional observational comparisons of peripheral blood from DMF-treated MS patients (n=17 lymphopenic, 24 non-lymphopenic), untreated MS patients (n=17) and healthy controls (n=23) that was immunophenotyped using flow cytometry. Longitudinal samples were analyzed for 13 DMF-treated patients. Results Lymphopenic DMF-treated patients had significantly fewer circulating CD8+ and CD4+ T-cells, CD56dim NK cells, CD19+ B-cells and plasmacytoid dendritic cells compared to controls. CXCR3+ and CCR6+ expression was disproportionately reduced among CD4+ T-cells while the proportion of T regulatory cells was unchanged. DMF did not affect circulating CD56hi NK-cells, monocytes or myeloid dendritic cells. Whether lymphopenic or not, DMF-treated patients had a lower proportion of circulating central and effector memory T cells and concomitant expansion of naïve T cells compared to controls. Conclusions DMF shifts the immunophenotypes of circulating T cells, causing reduction of memory cells and relative expansion of naïve cells regardless of absolute lymphocyte count. This may represent one mechanism of action of the drug. Lymphopenic patients had disproportionate loss of CD8+ T cells, which may affect their immunocompetence.

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Section: Introductionmentioning

confidence: 99%

Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients

et al. 2015

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“…Other opportunistic infections may also be possible, given reported infectious complications that occurred with fumaric acid esters. 7 Low CD4 counts might especially increase risk of PML, if HIV-related PML serves as any guide, although no monitoring guidelines for CD4/CD8 monitoring are available. The manufacturer estimates that 175,000 patients have been treated with DMF.…”

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confidence: 99%

Nonfatal PML in a patient with multiple sclerosis treated with dimethyl fumarate

Baharnoori

Lyons

Dastagir

et al. 2016

Neurol Neuroimmunol Neuroinflamm

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“…KS can involve the skin and other internal organs and four clinical subsets are currently recognized: classic, endemic, iatrogenic, and AIDS-related345. Development of KS in psoriasis patients has rarely been reported in spite of the fact that the current treatments of psoriasis are aimed at inhibiting the immune system1. We herein report a 71-year-old man with simultaneous occurrence of KS and psoriasis.…”

Section: Introductionmentioning

confidence: 89%

“…The pathogenesis of psoriasis is still not yet completely understood, but it is clear that immune cells induce alterations of tissue cell function which lead to regeneration-like reactions of the skin1. Kaposi's sarcoma (KS) is an endothelial proliferating vascular disease with different modes of manifestation and human papillomavirus-8 (HHV-8) is considered to be the necessary cause of all variants of KS2.…”

Section: Introductionmentioning

confidence: 99%

Hidden Pictures of Kaposi's Sarcoma in Psoriatic Lesions: A Diagnostic Challenge

Yoo

Kim

et al. 2016

Ann Dermatol

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Kaposi's sarcoma is a multifocal proliferative vascular tumor involving the skin and other organ and psoriasis is a chronic cutaneous disease with papules and plaques with white scale. Development of Kaposi's sarcoma in psoriasis patients has been reported rarely. A 71-year-old man presented with multiple brownish to violaceous plaques on both feet and arms which were found 4 months ago. The biopsy confirmed Kaposi's sarcoma. The patient was diagnosed with psoriasis vulgaris 10 years ago and Kaposi's sarcoma lesions developed between psoriatic plaques. We herein report a rare case of simultaneous occurrence of Kaposi's sarcoma and psoriasis vulgaris which need quite different treatment.

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Immunological changes in psoriasis patients under long-term treatment with fumaric acid esters: risk of Kaposi sarcoma occurrence?

Cited by 21 publications

References 0 publications

Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients

Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients

Nonfatal PML in a patient with multiple sclerosis treated with dimethyl fumarate

Hidden Pictures of Kaposi's Sarcoma in Psoriatic Lesions: A Diagnostic Challenge

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