The Yin and Yang of TNF-α Inhibition

Fiorentino, David

doi:10.1001/archderm.143.2.233

Cited by 66 publications

(23 citation statements)

References 12 publications

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“…5 Another hypothesis suggests that inhibition of TNF-␣ promotes the expression of type 1 interferon by altering the balance between T H 1 and T H 2 cytokine production, leading to the induction of autoimmune diseases such as lupus erythematosus, dermatomyositis, and vasculitis. 19,20 Although injection site reactions after anti-TNF therapy have been implicated as playing a role in direct antigen-mediated hypersensitivity vasculitis, 9 none of the 8 patients in our cohort had a documented injection site reaction before the development of vasculitis.…”

Section: Figurementioning

confidence: 80%

Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

Sokumbi

Wetter

Makol

et al. 2012

Mayo Clinic Proceedings

163

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Objective: To describe the clinical characteristics, histopathologic features, and outcomes of patients in whom vasculitis developed in association with use of tumor necrosis factor-␣ (TNF-␣) inhibitors. Patients and Methods: This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced by anti-TNF-␣ therapy. Results: Of 8 patients with vasculitis associated with anti-TNF-␣ therapy (mean age, 48.5 years), 6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease, and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%) with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before development of vasculitis was 34.5 months. The skin was the predominant organ affected (5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4 of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were histopathologically confirmed. Seven of 8 patients improved with discontinuation of therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received prednisone; another agent was also used in 7); rechallenge with anti-TNF-␣ therapy was not attempted in any patient. At last follow-up, no patients had experienced a recurrence of vasculitis after therapy discontinuation. Conclusion: Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis, including peripheral nerve and renal vasculitis, was also frequently observed.

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Section: Figurementioning

confidence: 80%

Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

Sokumbi

Wetter

Makol

et al. 2012

Mayo Clinic Proceedings

163

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“…In select, possibly genetically prone patients, TNF-a inhibition might disrupt a delicate immune balance, pushing the immune system toward IFN-a production, and triggering pathological activation of latent T cells and dendritic cells. 2,28,29 The model of anti-TNF-a induction of IFN-a could hold relevance for LP and lichenoid eruptions as well. Dramatic increases in plasmacytoid dendritic cells, the primary source of IFN-a, have been found in the cutaneous and oral lesions of LP.…”

Section: Discussionmentioning

confidence: 99%

Lichen planus–like eruptions: An emerging side effect of tumor necrosis factor-α antagonists

Asarch

Gottlieb

Liu

et al. 2009

Journal of the American Academy of Dermatology

170

105

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“…The possibility of misdiagnosis of the primary rheumatological disease exists, and psoriatic arthritis may precede psoriasis in approximately 15% of cases. Alternatively, the patients with psoriasis as an adverse event may have a genetic predisposition to psoriasis, which after all is not uncommon (prevalence 2.5%), in addition to their arthritis 33. Others have suggested that the adverse event is not psoriasis but either a drug hypersensitivity reaction such as acute generalised exanthaematous pustulosis14 or a bacterial infection due to the inhibition of TNFα 15 34.…”

Section: Discussionmentioning

confidence: 99%

Rates of new-onset psoriasis in patients with rheumatoid arthritis receiving anti-tumour necrosis factor α therapy: results from the British Society for Rheumatology Biologics Register

et al. 2008

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Background:Anti-tumour necrosis factor (TNF)α treatments improve outcome in severe rheumatoid arthritis (RA) and are efficacious in psoriasis and psoriatic arthritis. However recent case reports describe psoriasis occurring as an adverse event in patients with RA receiving anti-TNFα therapy.Objectives:We aimed to determine whether the incidence rate of psoriasis was higher in patients with RA treated with anti-TNFα therapy compared to those treated with traditional disease-modifying antirheumatic drugs (DMARDs). We also compared the incidence rates of psoriasis between the three anti-TNFα drugs licensed for RA.Methods:We studied 9826 anti-TNF-treated and 2880 DMARD-treated patients with severe RA from The British Society for Rheumatology Biologics Register (BSRBR). All patients reported with new onset psoriasis as an adverse event were included in the analysis. Incidence rates of psoriasis were calculated as events/1000 person years and compared using incidence rate ratios (IRR).Results:In all, 25 incident cases of psoriasis in patients receiving anti-TNFα therapy and none in the comparison cohort were reported between January 2001 and July 2007. The absence of any cases in the comparison cohort precluded a direct comparison; however the crude incidence rate of psoriasis in those treated with anti-TNFα therapy was elevated at 1.04 (95% CI 0.67 to 1.54) per 1000 person years compared to the rate of 0 (upper 97.5% CI 0.71) per 1000 person years in the patients treated with DMARDs. Patients treated with adalimumab had a significantly higher rate of incident psoriasis compared to patients treated with etanercept (IRR 4.6, 95% CI 1.7 to 12.1) and infliximab (IRR 3.5, 95% CI 1.3 to 9.3).Conclusions:Results from this study suggest that the incidence of psoriasis is increased in patients treated with anti-TNFα therapy. Our findings also suggest that the incidence may be higher in patients treated with adalimumab.

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The Yin and Yang of TNF-α Inhibition

Cited by 66 publications

References 12 publications

Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

Vasculitis Associated With Tumor Necrosis Factor-α Inhibitors

Lichen planus–like eruptions: An emerging side effect of tumor necrosis factor-α antagonists

Rates of new-onset psoriasis in patients with rheumatoid arthritis receiving anti-tumour necrosis factor α therapy: results from the British Society for Rheumatology Biologics Register

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