New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus

Pasin, Victor Pavan; Pereira, Amanda; Carvalho, Kalline Andrade de; Paiva, João Marcos Góes de; Enokihara, Mílvia Maria Simões e Silva; Porro, Adriana María

doi:10.1590/abd1806-4841.20153672

Cited by 9 publications

(3 citation statements)

References 9 publications

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“…3,5,8,9 We identified only one case report describing oral and perianal ulcers due to mTOR inhibitor therapy in a 38-year-old HIV-positive kidney transplant patient. 10 This patient presented high serum levels of everolimus 11.7 ng/mL (target area 3-8 ng/mL) and ulcers that healed only 40 days after everolimus discontinuation. In both ours and that case, no common pathogen was found to be responsible for the ongoing ulceration, and ulcer histopathology in both patients revealed non-specific ulcers, with scarce inflammatory lymphocytic infiltrates and no signs of an acute vasculitis or malignancy.…”

Section: Discussionmentioning

confidence: 84%

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Everolimus‐associated perianal ulcers in an eight‐month‐old heart transplant recipient

Spehl

Fleck

Schauer

et al. 2017

Pediatric Transplantation

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mTOR inhibitors have a wide spectrum of therapeutic applications in adults and children. Little is known, however, about serious adverse effects in children undergoing mTOR inhibitor therapy. Oral ulcers are common and sometimes severe, but no other gastrointestinal involvement has been reported so far. Here we present a case of everolimus-associated perianal ulcers in an eight-month-old infant, 3 months after heart transplantation, which necessitated the drug's discontinuation. In a thorough series of diagnostic tests, we identified no other cause for the progressive perianal ulceration. The recognition and appropriate management of mTOR inhibitors' adverse effects in pediatric patients are essential and remain challenging.

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Section: Discussionmentioning

confidence: 84%

“…We identified only one case report describing oral and perianal ulcers due to mTOR inhibitor therapy in a 38‐year‐old HIV‐positive kidney transplant patient . This patient presented high serum levels of everolimus 11.7 ng/mL (target area 3‐8 ng/mL) and ulcers that healed only 40 days after everolimus discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Everolimus‐associated perianal ulcers in an eight‐month‐old heart transplant recipient

Spehl

Fleck

Schauer

et al. 2017

Pediatric Transplantation

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“…They observed that one-third of patients converted to sirolimus experienced aphthous-type mouth ulcers that resolved over the course of the first 2 weeks with dose adjustment to the lower end of the target range, although three patients developed coincidental herpes simplex [68]. Everolimus is also associated with mouth ulcers [69,70] and perianal ulcers [70,71]. It is often dose-related, especially in those on steroid-free immunosuppression and after conversion from CNIs.…”

Section: Mouth Ulcersmentioning

confidence: 99%

Adverse Drug Events after Kidney Transplantation

Rostaing,

Jouve,

Terrec

et al. 2023

JPM

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Introduction: Kidney transplantation stands out as the optimal treatment for patients with end-stage kidney disease, provided they meet specific criteria for a secure outcome. With the exception of identical twin donor–recipient pairs, lifelong immunosuppression becomes imperative. Unfortunately, immunosuppressant drugs, particularly calcineurin inhibitors like tacrolimus, bring about adverse effects, including nephrotoxicity, diabetes mellitus, hypertension, infections, malignancy, leukopenia, anemia, thrombocytopenia, mouth ulcers, dyslipidemia, and wound complications. Since achieving tolerance is not feasible, patients are compelled to adhere to lifelong immunosuppressive therapies, often involving calcineurin inhibitors, alongside mycophenolic acid or mTOR inhibitors, with or without steroids. Area covered: Notably, these drugs, especially calcineurin inhibitors, possess narrow therapeutic windows, resulting in numerous drug-related side effects. This review focuses on the prevalent immunosuppressive drug-related side effects encountered in kidney transplant recipients, namely nephrotoxicity, post-transplant diabetes mellitus, leukopenia, anemia, dyslipidemia, mouth ulcers, hypertension, and viral reactivations (cytomegalovirus and BK virus). Additionally, other post-kidney-transplantation drugs such as valganciclovir may also contribute to adverse events such as leukopenia. For each side effect, we propose preventive measures and outline appropriate treatment strategies.

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Cutaneous Side Effects of Immunosuppressive Drugs Other Than Neoplasms

Miotto

Oliveira

2022

Atlas of Dermatologic Diseases in Solid Organ Transplant Recipients

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New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus

Cited by 9 publications

References 9 publications

Everolimus‐associated perianal ulcers in an eight‐month‐old heart transplant recipient

Everolimus‐associated perianal ulcers in an eight‐month‐old heart transplant recipient

Adverse Drug Events after Kidney Transplantation

Cutaneous Side Effects of Immunosuppressive Drugs Other Than Neoplasms

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