First case of drug rash eosinophilia and systemic symptoms due to boceprevir

Samain, A; Duval-Modeste, Anne-Bénédicte; Joly, P.; Leblanc, Céline; Massy, Nathalie; Courville, Philippe; Goria, Odile; Riachi, Ghassan

doi:10.1016/j.jhep.2013.12.008

Cited by 13 publications

(4 citation statements)

References 14 publications

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“…36 In our study there was similarity in frequency of DAEs in BOC and TVR groups (28% in TVR group and 21% in BOC group (p=0,481 test Chi 2 ) however the intensity of DAEs was milder in BOC group. In our study anorectal discomfort was present only in TVR treated group in 20% of patients.…”

Section: J Dermatol Case Rep 2014 4 Pp 95-102supporting

confidence: 59%

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Kłujszo¹,

Parcheta²,

Zarębska-Michaluk

et al. 2014

J Dermatol Case Rep

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Background: Combination therapy with pegylated interferon, ribavirin and a firstgeneration NS3/4A protease inhibitor, telaprevir or boceprevir, is the new strategy for treatment of genotype 1 chronic hepatitis C virus infection. This combination improves therapeutic efficacy but it also increases the risk of adverse events. Objective:The aim of the study was to analyze frequency and severity of dermatological adverse events during protease inhibitor-based therapy and to evaluate the risk factors for their development. Patients and methods:This is a retrospective study of 109 patients with genotype 1 chronic hepatitis C treated with boceprevir (n=33) or telaprevir (n=76) based triple therapy. A logistic regression for relationship between clinical, demographic and laboratory factors and cutaneous adverse events was performed.Results: Dermatological adverse events (skin rash, pruritus, anorectal paresthesia) occurred in both treatments (boceprevir and telaprevir) with similar frequency: 28% in telaprevir and 21% in boceprevir. In patients treated with telaprevir, men were more predisposed to develop skin rashes compared to women (OR 4,1 p=0,014) and age above 45 years was associated with occurrence of pruritus in men (OR 8,16 p=0,014). Being a female, coexistence of autoimmune thyroiditis and advanced liver fibrosis were independent factors predisposing to development of anorectal paresthesia (OR 4,13 p=0,041, OR 4,25 p=0,029, OR 4,54 p=0,018 respectively) in this group. In patients treated with boceprevir, coexistence of autoimmune thyroiditis predisposed to skin rashes (OR 10,22 p=0,017) and being a female predisposed to pruritus (OR11,2 p=0,033). The adverse events occurred after a mean time of 8,6 (range 1-24) weeks after initiation of therapy. Conclusions:In patients with chronic hepatitis C who received the triple therapy, the anorectal paresthesias were observed only in patients treated with telaprevir. The predisposing factors for this adverse event were: female gender and advanced liver fibrosis. The risk factors for other dermatological adverse were: 1) being a male over 45 years, for skin rashes and pruritus (for telaprevir), 2) coexistence of autoimmune thyroiditis for skin rashes (for boceprevir), 3) being a female, for pruritus (for boceprevir). (J Dermatol Case Rep. 2014; 8(4): 95-102)

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Section: J Dermatol Case Rep 2014 4 Pp 95-102supporting

confidence: 59%

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Kłujszo¹,

Parcheta²,

Zarębska-Michaluk

et al. 2014

J Dermatol Case Rep

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“…These include anti-hepatitis C virus agents (boceprevir and telaprevir) [42,43,44], targeted therapies for oncological diseases (sorafenib [46], vismodegib [47], and vemurafenib [48]), a new anti-coagulant (rivaroxaban) [49], and a new uric acid-lowering agent (fubuxostat) [50]. Although these agents are not notorious for inducing DRESS syndrome, such reports reflect the fact that with increasing introductions of new drugs, the list of culprit drugs for DRESS syndrome will continue to grow.…”

Section: Clinical Featuresmentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

Cho

Yang

Chu

2017

IJMS

213

276

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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by a limited number of eliciting drugs in patients with a genetic predisposition. Patients with DRESS syndrome present with characteristic but variable clinical and pathological features. Reactivation of human herpesviruses (HHV), especially HHV-6, is the hallmark of the disease. Anti-viral immune responses intertwined with drug hypersensitivity make the disease more complicated and protracted. In recent years, emerging studies have outlined the disease more clearly, though several important questions remain unresolved. In this review, we provide an overview of DRESS syndrome, including clinical presentations, histopathological features, pathomechanisms, and treatments.

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“…Rashes were noted in 14 to 22% of cases and dry skin in 18 to 22% of cases, which was noted more significantly compared to PegIFN and RBV alone in treatment experienced patients, however, no patient receiving boceprevir discontinued the treatment because of skin eruption 68 . Severe cutaneous syndromes are uncommon with boceprevir, with one recently published case of DRESS/DIHS associated with boceprevir 69 . For mild to moderate skin rash without systemic symptoms or mucosal involvement, appropriate skin-care management usually facilitates continuation of antiviral therapy 70 (Table 3).…”

Section: Hypersensitivity Syndromes Associated With Treatment Of Hepamentioning

confidence: 99%

Antiviral Drug Allergy

Milpied-Homsi

Moran

Phillips

2014

Immunology and Allergy Clinics of North America

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Antiviral drugs used to treat HIV and hepatitis C are common causes of delayed drug hypersensitivities for which many of the more severe reactions have been recently shown to be immunogenetically mediated such as abacavir hypersensitivity where HLA-B*57:01 is now used routinely as a screening test to exclude patients carrying this allele from abacavir prescription. Most antiviral drug allergies consist of mild to moderate delayed rash without other serious features (e.g. fever, mucosal involvement, blistering rash, organ impairment. In these cases treatment can be continued with careful observation and symptomatic management and the discontinuation rate is low.

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First case of drug rash eosinophilia and systemic symptoms due to boceprevir

Cited by 13 publications

References 14 publications

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

Antiviral Drug Allergy

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