Vitiligo during Treatment of Crohn’s Disease with Adalimumab: Adverse Effect or Co-Occurrence

Posada, Celia; Flórez, Ángeles; Batalla, Ana; Alcázar, Juan José; Carpio, Daniel

doi:10.1159/000324619

Cited by 23 publications

(20 citation statements)

References 8 publications

(16 reference statements)

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“…There are also 18 reported patients who developed de novo vitiligo after initiating therapy with a TNF‐α antagonist for nonvitiligo conditions. Seven of these patients are detailed in case reports, with an additional eight patients in one case series and three reported in observational studies . In two observational studies looking at adverse cutaneous events that developed during TNF‐α antagonist treatment for rheumatological conditions, one of 5437 patients developed vitiligo in one study, and one of 435 patients developed vitiligo in another .…”

Section: Mixed Results For Tumour Necrosis Factor‐α Antagonists In Thmentioning

confidence: 99%

Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo

et al. 2015

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TNF-α, a proinflammatory cytokine central to many autoimmune diseases, has been implicated in the depigmentation process in vitiligo. We reviewed its role in vitiligo by exploring its pro- and anti-inflammatory properties and examined the effects of blocking its actions with TNF-α antagonist therapeutics in reports available in the literature. We found that TNF-α inhibition halts disease progression in patients with progressive vitiligo but that, paradoxically, treatment can be associated with de novo vitiligo development in some patients when used to treat other autoimmune conditions, particularly when using adalimumab and infliximab. These studies reinforce the importance of stating appropriate outcomes measures as most pilot trials proposed to measure repigmentation, whereas halting depigmentation was commonly overlooked as a measure of success. We conclude that TNF inhibition was useful for patients with progressive vitiligo, where TNF-α inhibition is able to quash cytotoxic T cell-mediated melanocyte destruction. However, a lingering concern for initiating de novo disease will likely prevent a more widespread application of TNF inhibitors to treat vitiligo.

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Section: Mixed Results For Tumour Necrosis Factor‐α Antagonists In Thmentioning

confidence: 99%

Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo

et al. 2015

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“…Therefore, anti-TNF therapy could be used to treat pre-existing or active vitiligo, supporting the use of anti-TNF agents as a viable therapeutic option for vitiligo (Alghamdi et al, 2012;Carvalho and Ortigosa, 2014;Kim et al, 2011;Rigopoulos et al, 2007;Simon and Burgos-Vargas, 2008). However, other studies suggest that anti-TNF therapy may induce de novo vitiligo in patients with other autoimmune disease without pre-existing vitiligo (Carvalho and Ortigosa, 2014;Exarchou et al, 2009;Ismail et al, 2011;Lahita and Vernace, 2011;Maruthappu et al, 2013;Mattox et al, 2013;Posada et al, 2011;Ramirez-Hernandez et al, 2005). Our data support previous reports that TNF blockage can cause vitiligo in patients who have never had vitiligo before.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Vitiligo Following Anti-Tumor Necrosis Factor Therapy: A 10-Year Population-Based Cohort Study

Bae

Kim

Lee

et al. 2018

Journal of Investigative Dermatology

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Anti-tumor necrosis factor-α (anti-TNF) therapy is used to treat a wide range of chronic inflammatory conditions. However, there has been an increasing number of reports of development of vitiligo and alopecia areata secondary to anti-TNF therapy. In this study, we investigated the risks of vitiligo and alopecia areata in patients with ankylosing spondylitis, Crohn's disease, or ulcerative colitis, who were treated with or without anti-TNF therapy using data from the Korean National Health Insurance Claims database from 2007 to 2016. The study comprised 11,442 patients treated with anti-TNF agents (anti-TNF group), and an equal number of age-, sex-, and disease- matched patients treated without anti-TNF agents (unexposed group). Multivariable Cox proportional hazards models were used to compare the risks of vitiligo and alopecia areata between the two groups. A significantly increased risk of vitiligo (hazard ratio = 1.99, 95% confidence interval = 1.06-3.75) was observed in the anti-TNF group compared to the unexposed group (5.9/10,000 person-years vs. 2.5/10,000 person-years). In subgroup analyses, younger patients and those treated with etanercept showed higher risks of vitiligo. The risk of alopecia areata was not significantly different between the two groups. Our results provide insight on the role of cytokine imbalance in the pathogenesis of vitiligo.

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“…Anti TNF‐α therapy also has induced paradoxical IBD in patients with inflammatory rheumatic disease and juvenile idiopathic arthritis . Vitiligo and alopecia areata are other paradoxical outcomes of anti‐TNF therapy …”

Section: Paradoxes Of Newly Emerging Drugs For Admentioning

confidence: 99%

“…79,80 Vitiligo and alopecia areata are other paradoxical outcomes of anti-TNF therapy. [81][82][83] Tocilizumab and ustekinumab have been reported to be associated with psoriasis reactivation/flare-ups. 84,85 Surprisingly, exacerbation of infliximab-induced paradoxical psoriasis after ustekinumab therapy also has been reported.…”

Section: Paradoxes Of Newly Emerging Drugs For Admentioning

confidence: 99%

Pharmacogenetics: A strategy for personalized medicine for autoimmune diseases

2018

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For many years, a considerable number of patients with autoimmune diseases (ADs) have suffered from a lack of drug response and drug-related toxicity. Despite the emergence of new therapeutic options such as biological agents, patients continue to struggle with these problems. Unfortunately, new challenges, including the paradoxical effects of biological drugs, have complicated the situation. In recent decades, efforts have been made to predict drug response as well as drug-related side effects. Thanks to the many advances in genetics, evaluation of markers to predict drug response/toxicity before the initiation of treatment may be an avenue toward personalizing treatments. Implementing pharmacogenetics and pharmacogenomics in the clinic could improve clinical care; however, obstacles remain to effective personalized medicine for ADs. The present study attempted to clarify the concept of pharmacogenetics/pharmacogenomics for ADs. After an overview on the pathogenesis of the most common types of treatments, this paper focuses on pharmacogenetic studies related to the selected ADs. Bridging the gap between pharmacogenetics and personalized medicine is also discussed. Moreover, the advantages, disadvantages and recommendations related to making personalized medicine practical for ADs have been addressed.

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Vitiligo during Treatment of Crohn’s Disease with Adalimumab: Adverse Effect or Co-Occurrence

Cited by 23 publications

References 8 publications

Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo

Tumour necrosis factor-α inhibition can stabilize disease in progressive vitiligo

Increased Risk of Vitiligo Following Anti-Tumor Necrosis Factor Therapy: A 10-Year Population-Based Cohort Study

Pharmacogenetics: A strategy for personalized medicine for autoimmune diseases

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