Prevalence and Management of Panic Attacks during Infliximab Infusion in Psoriatic Patients

Saraceno, Rosita; Faleri, Sara; Ruzzetti, Manuela; Centonze, Diego; Chimenti, Sergio

doi:10.1159/000343609

Cited by 4 publications

(2 citation statements)

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“…Three studies assessing lifetime prevalence of anxiety were not included in the meta-analysis ( 23 – 25 ). The studies selected for the meta-analysis of the prevalence of anxiety are listed in Table SII ( 26 – 126 ).…”

Section: Resultsmentioning

confidence: 99%

Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi

Jalenques

Bourlot²,

Martínez³

et al. 2022

Acta Derm Venereol

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The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.

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Section: Resultsmentioning

confidence: 99%

Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi

Jalenques

Bourlot²,

Martínez³

et al. 2022

Acta Derm Venereol

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“…Infliximab, a monoclonal antibody directed against TNF with anti-inflammatory and anti-oxidative effects, was recently shown to have antidepressive effects in patients with initially increased CRP levels [71]. Nevertheless, Etanercept and Infliximab, two anti-TNF agents used in juvenile arthritis and psoriasis, arthritis and inflammatory bowel disease in adults, have a long list of potentially severe side effects including depression, suicide, induction of mania, nervousness, anxiety, panic, aggressiveness, fatigue, sleep disorders [72][73][74][75]. While anti-TNF agents have anti-inflammatory and antioxidative effects and reduce Th1 and Th17 responses these drugs may cause infections and autoimmune responses [76].…”

Section: Gaps and Required Improvements: New Treatmentsmentioning

confidence: 99%

Toward Omics-Based, Systems Biomedicine, and Path and Drug Discovery Methodologies for Depression-Inflammation Research

et al. 2015

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Meta-analyses confirm that depression is accompanied by signs of inflammation including increased levels of acute phase proteins, e.g. C-reactive protein, and pro-inflammatory cytokines, e.g. interleukin-6. Supporting the translational significance of this, a meta-analysis showed that anti-inflammatory drugs may have antidepressant effects. Here we argue that inflammation and depression research needs to get onto a new track. Firstly, the choice of inflammatory biomarkers in depression research was often too selective and did not consider the broader pathways.Secondly, although mild inflammatory responses are present in depression, other immune-related pathways cannot be disregarded as new drug targets, e.g. activation of cell-mediated immunity, oxidative and nitrosative stress (O&NS) pathways, autoimmune responses, bacterial translocation, activation of the Toll-like Receptor and neuroprogressive pathways. Thirdly, antiinflammatory treatments are sometimes used without full understanding of their effects on the broader pathways underpinning depression. Since many of the activated immune-inflammatory pathways in depression actually confer protection against an overzealous inflammatory response, targeting these pathways may result in unpredictable and unwanted results. Furthermore, this paper discusses the required improvements in research strategy, i.e. path and drug discovery processes, omics-based techniques and systems biomedicine methodologies. Firstly, novel methods should be employed to examine the intracellular networks that control and modulate the immune, O&NS and neuroprogressive pathways using omics-based assays, including genomics, transcriptomics, proteomics, metabolomics, epigenomics and microbiomics. Secondly, systems biomedicine analyses are essential to unravel the complex interactions between these cellular 4 networks, pathways and the multifactorial trigger factors and to delineate new drug targets in the cellular networks or pathways. Drug discovery processes should delineate new drugs targeting the intracellular networks and immune-related pathways.

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Infliximab

2013

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Infliximab Panic attacks: 6 case reportsIn a retrospective study of 141 patients, four women and two men, aged 33-75 years, were identified after they developed panic attacks while receiving infliximab [Remicade].The six patients, who had either psoriatic arthritis or plaquetype psoriasis, were receiving IV infusions of infliximab 5 mg/kg over 2-3 hours at weeks 0, 2 and 6 during induction, and every 8 weeks thereafter. After the first 20 minutes of each administration, the infusion rate was increased from 60 mL/h to 120 mL/h. All patients experienced panic attacks during infliximab infusions, with the first episode developing during either the first, second, tenth, 20th or 24th infusion. The panic attacks occurred in each case after the infusion rate was increased. The symptoms included intense discomfort, palpitations, accelerated heart rate, nausea, muscle tension, hot flashes, a shortness of breath sensation, cough, trembling, sweating and a fear of dying. These symptoms would peak after 5 minutes and resolve within 10 minutes. Psychiatric and psychological consultations confirmed the diagnosis in each case. Infliximab was interrupted for 30-40 minutes to differentiate the presence of panic attacks with and without infusion reactions. After resolution of symptoms, infliximab infusions were restarted at a lower rate; five patients received diazepam. Two patients experienced recurrent panic attacks with each infusion. These patients received premedication with diazepam, after which they had a lower rate of episodes with reduced symptom intensity. Author comment: "[I]n all cases, the clinical manifestations of panic disorders followed the acceleration of the infusion rate (after the first 20 min of intravenous [infliximab] administration). This temporal correlation underlines the possible pathogenetic role of [infliximab] intriggering the panic attack." Saraceno R, et al. Prevalence and management of panic attacks during infliximab infusion in psoriatic patients. Dermatology 225: 236-241, No. 3, 2012. Available from: URL: http://dx.

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Prevalence and Management of Panic Attacks during Infliximab Infusion in Psoriatic Patients

Cited by 4 publications

References 50 publications

Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi

Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi

Toward Omics-Based, Systems Biomedicine, and Path and Drug Discovery Methodologies for Depression-Inflammation Research

Infliximab

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