Infliximab in recalcitrant granuloma annulare

Bretèque, M. Amy de la; Saussine, A.; Rybojad, M.; Kramkimel, N.; Pennamen, Marie-Dominique Vignon; Bagot, M.; Guibal, F.

doi:10.1111/ijd.12458

Cited by 4 publications

(6 citation statements)

References 9 publications

(22 reference statements)

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“…reported a quick beneficial response in a patient treated with infliximab (5 mg/kg; weeks 0, 2 and 6, followed by monthly infusions for 4 months) without recurrence of new lesions during the observation period of more than 16 months. Similarly, Amy de la Breteque et al . reported a case with clearance of GA after therapy with infliximab (5 mg/kg; weeks 0, 2 and 6, followed by eight infusions every 2 months), which had a mild recurrence 18 months after therapy cessation.…”

Section: Discussionmentioning

confidence: 93%

“…We report a case of long-lasting resolution of recalcitrant GA after five infusions of infliximab (5 mg/kg) which correlated with a marked decrease of infiltrating myeloid dendritic cells, different macrophage populations and type 1 T cells (CXCR3 + ) in the skin. Our case confirms previous reports indicating a beneficial therapeutic effect for TNF-a inhibitors, namely adalimumab and infliximab, in disseminated GA. [4][5][6][7][8][9] However, little is known about the optimal treatment duration of these agents and remission after therapy discontinuation, especially over a period longer than 6 months. Min et al 5 recently reported treatment response in disseminated GA using adalimumab.…”

Section: Discussionmentioning

confidence: 99%

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Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Bürgler

Vinay

Häfliger

et al. 2019

The Journal of Dermatology

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Disseminated granuloma annulare (GA) is a rare granulomatous dermatitis of unknown etiology. Treatment is often challenging and lack of a uniformly effective treatment, adds to the disease morbidity. Tumor necrosis factor (TNF)‐α is an important cytokine in granuloma formation and previous reports have shown improvement of disseminated GA with anti‐TNF‐α therapy. Nevertheless, the underlying mechanism of actions of TNF‐α inhibitors in GA remains unclear. Our aim was to evaluate alterations in the inflammatory infiltrate in a patient who experienced complete clearance of GA after treatment with infliximab. A skin biopsy was obtained before and 24 weeks after treatment with infliximab 5 mg/kg at weeks 0, 2, 6, 14 and 24. Immunohistochemical stains were performed in pre‐ and post‐treatment biopsy specimens using CD1a, CD4, CD8, CD11c, CD32, CD68, CD69, CD163, CD183 and human leukocyte antigen (HLA)‐DR to characterize alterations of the infiltrates. Parallel with clinical improvement, we observed a marked decrease in myeloid (CD11c) dendritic cells, different macrophage subsets (CD68, CD32, CD163) and T cells. In addition, a marked reduction of activation markers (HLA‐DR, CD69) and CD183+ (CXCR3) cells was observed in post‐treatment biopsy specimens. In conclusion, the clinical improvement of disseminated GA by infliximab is paralleled by inhibition of activated myeloid dendritic cells, different macrophage subsets and type 1 T cells.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Bürgler

Vinay

Häfliger

et al. 2019

The Journal of Dermatology

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“…2010; 11:437-9 Intralesional rhu-IFN-g injections Weiss et al 19 Patient 1 demonstrated no change and even deterioration in their condition with treatment with etanercept, which, unlike adalimumab and infliximab, is unable to bind transmembrane TNF-a. 16,29 Other research has also suggested that the inferiority of etanercept with respect to agents such as adalimumab and infliximab may be due to its inability to bind transmembrane TNF-a and consequently aid in the destruction of granulomas. 29 The existing level of evidence for treatment of GA and these other granulomatous conditions is limited to case reports, retrospective analysis, and expert opinion.…”

Section: Resultsmentioning

confidence: 99%

“…These mechanisms possibly explain the effectiveness of adalimumab and infliximab in other granulomatous disease, such as Crohn's disease. Interestingly, a group of four patients demonstrated no change and even deterioration in their condition with treatment with etanercept, which, unlike adalimumab and infliximab, is unable to bind transmembrane TNF‐α . Other research has also suggested that the inferiority of etanercept with respect to agents such as adalimumab and infliximab may be due to its inability to bind transmembrane TNF‐α and consequently aid in the destruction of granulomas …”

Section: Discussionmentioning

confidence: 99%

The role of biologics in the treatment of chronic granuloma annulare

2019

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Background Granuloma annulare (GA), a benign inflammatory skin disease, is considered a Th1‐type delayed hypersensitivity reaction. Localized GA is likely to resolve spontaneously, whereas disseminated GA (DGA) may persist for decades and can be resistant to treatment. Biologics including TNF‐α inhibitors have been proposed and utilized as salvage therapy for GA and other related diseases, interstitial granulomatous dermatitis (IGD), and actinic granuloma (AG). Methods A systematic review was conducted using the combination of search terms “granuloma annulare,” “interstitial granulomatous dermatitis,” or “actinic granuloma” and either “biologics,” “etanercept,” “adalimumab,” “infliximab,” “ustekinumab,” “ixekizumab,” “secukinumab,” “guselkumab,” “golimumab,” “brodalumab,” “tildrakizumab,” or “certolizumab” from the years 1970–2017. Results Review of the literature revealed that 79.3% of the patients with GA, IGD, or AG who had been treated with demonstrated TNF‐α inhibitor therapy a clinical response. Conclusions TNF‐α inhibitor therapy has been used to treat chronic GA, IGD, and AG that involved extensive body surface areas. However, the literature is limited to case series lacking control groups. Randomized, controlled trials are required to establish evidence‐based treatment of GA and related cutaneous, granulomatous conditions.

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“…fortunately, the lesions cleared after discontinuing therapy but re-appeared upon exposure to etanercept. 71 Infliximab also has been effective for patients with recalcitrant GA 72 and recalcitrant disseminated GA 73 but there are reports of GA thought to have been caused by TNF antagonists including infliximab. 74 Necrobiosis Lipoidica Infliximab, etanercept, and adalimumab have been used in patients with necrobiosis lipoidica, and may be particularly helpful in cases of ulcerative necrobiosis lipoidica resistant to conventional therapies.…”

Section: Sarcoidosismentioning

confidence: 99%

Off-Label uses of Biologic Agents Approved for Psoriasis and Psoriatic Arthritis for Dermatological Conditions: Part I

Elbendary

Kellen

2016

Journal of Psoriasis and Psoriatic Arthritis

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Over the past decade or so, the treatment of patients with psoriasis has been revolutionized by the development of the biological agents, monoclonal antibodies that target specific aspects of the inflammatory cascades. The biologic agents approved by the Food and Drug Administration for psoriasis and psoriatic arthritis include adalimumab, etanercept, infliximab, ustekinumab, and secukinumab. The advantages of these agents are numerous: they are dosed less frequently than previously used systemic agents, they have a more favorable safety profile, and they have incredible efficacy even in patients resistant to standard treatment. There are abundant reports of off-label uses of these drugs for other dermatological conditions and inflammatory dermatoses. This review highlights the ability of the biologic agents to treat a wide spectrum of dermatologic diseases.

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Infliximab in recalcitrant granuloma annulare

Cited by 4 publications

References 9 publications

Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

Infliximab reduces activated myeloid dendritic cells, different macrophage subsets and CXCR3‐positive cells in granuloma annulare

The role of biologics in the treatment of chronic granuloma annulare

Off-Label uses of Biologic Agents Approved for Psoriasis and Psoriatic Arthritis for Dermatological Conditions: Part I

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