Organising pneumonia associated with fumaric acid ester treatment for psoriasis

Deegan, Alexander P; Kirby, Brian; Rogers, S.; Crotty, Tom; McDonnell, T.J.

doi:10.1111/j.1752-699x.2009.00180.x

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…Twenty‐four case reports described adverse events associated with treatment with FAEs (Table ). Of these, several involved immunosuppressive events linked to FAE‐induced lymphocytopenia, including Kaposi sarcoma, organizing pneumonia, tuberculous lymphadenitis, squamous cell carcinoma, melanoma and progressive multifocal leukoencephalopathy (PML) . Seven cases of PML associated with treatment with FAEs have been reported.…”

Section: Resultsmentioning

confidence: 99%

Efficacy, effectiveness and safety of fumaric acid esters in the treatment of psoriasis: a systematic review of randomized and observational studies

et al. 2016

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Fumaric acid esters (FAEs) are increasingly used as a systemic treatment for psoriasis, but there are still uncertainties regarding their suitability. The objective of this systematic review was to assess the evidence for the efficacy and safety of FAEs in psoriasis treatment. A systematic literature search was performed in seven databases up to 17 August 2015. Inclusion criteria were studies that reported clinical effects of FAEs in patients with psoriasis without restrictions in study design, language or publication date. Methodological quality of randomized controlled trials (RCTs) and overall level of quality were assessed using the Cochrane risk of bias tool and the Grading of Recommendation, Assessment, Development and Evaluation approach, respectively. A total of 68 articles were included. There were seven RCTs (total 449 patients) that had an unclear risk of bias and were too clinically heterogeneous to allow a meta-analysis. Overall, mean Psoriasis Area and Severity Index decreased by 42-65% following 12-16 weeks of treatment. There were 37 observational studies (a total of 3457 patients) that supported the RCT findings, but most were uncontrolled with a high risk of bias. Commonly reported adverse events included gastrointestinal complaints and flushing, leading to treatment withdrawal in 6-40% of patients. Several case-reports described rare adverse events, such as renal Fanconi syndrome and progressive multifocal leukoencephalopathy. There was a lack of studies focusing on long-term use and comparisons with other treatments. This review concluded that there is low-quality evidence to recommend the use of oral FAEs to treat plaque psoriasis in adult patients. Studies focusing on long-term safety and comparison with systemic psoriasis treatments could lead to a better understanding of the role of FAEs as a treatment for psoriasis.

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Section: Resultsmentioning

confidence: 99%

Efficacy, effectiveness and safety of fumaric acid esters in the treatment of psoriasis: a systematic review of randomized and observational studies

et al. 2016

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“…Of 447 patients who visited the ILD program in a referral practice, 21 ILD patients (4.7%) had concomitant psoriasis or psoriatic arthritis, and most of them (63.6%) had not been previously or concomitantly exposed to immunosuppressants. In previous studies (Table 3), the following immunosuppressants were associated with pneumonitis in patients with psoriasis: methotrexate [32], infliximab [26], fumaric acid ester [25], leflunomide [24], gold [18], and sulfasalazine [17]. In contrast, only 3 cases of ILD without concomitant or prior use of immunosuppressants have been reported.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Interstitial Lung Disease with Psoriasis

Ishikawa

Dua

Mathur

et al. 2019

Canadian Respiratory Journal

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Background. We encounter interstitial lung disease (ILD) patients with psoriasis. The aim of this case series was to examine clinical and radiographic characteristics of patients with concomitant psoriasis and ILD. Methods. This is a retrospective review of our institutional experience of ILD concomitant with psoriasis, from the database in the Advanced Lung/Interstitial Lung Disease Program at the Mount Sinai Hospital. Out of 447 ILD patients, we identified 21 (4.7%) with antecedent or concomitant diagnosis of psoriasis. Clinical, radiographic, pathological, and outcome data were abstracted from our medical records. Results. Median age was 66 years (range, 46–86) and 14 (66.7%) were male. Thirteen (61.9%) had not previously or concomitantly been exposed to immunosuppressive therapy directed against psoriasis. Two (9.5%) ultimately died. Clinical diagnosis of ILD included idiopathic pulmonary fibrosis, 11 (52.4%); nonspecific interstitial pneumonia (NSIP), 2 (9.5%); cryptogenic organizing pneumonia, 2 (9.5%); chronic hypersensitivity pneumonitis, 2 (9.5%); and the others, while radiographic diagnosis included usual interstitial pneumonia pattern, 9 (42.9%); NSIP pattern, 6 (28.6%); organizing pneumonia pattern, 4 (19.0%); hypersensitivity pneumonitis pattern, 2 (9.5%); and the others. Conclusions. We report 21 ILD cases with antecedent or concomitant diagnosis of psoriasis. Further prospective studies are required to determine the association between ILD and psoriasis.

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“…Less frequent occurring adverse events during FAE treatment are fatigue, headache, pruritus, and edema of the lower extremities. 24 In addition, there have been incidental reports of the development of organizing pneumonia, 78 squamous cell carcinoma, 79 melanoma, 80 and Kaposi sarcoma 81 during FAE treatment. These adverse events could possibly be related to FAE-induced lymphocytopenia.…”

Section: Resultsmentioning

confidence: 99%

Fumaric acid esters in the management of psoriasis

Balak

2015

PTT

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Fumaric acid esters (FAE) are small molecules with immunomodulating, anti-inflammatory, and anti-oxidative effects. FAE were introduced as a systemic psoriasis treatment in 1959 and empirically developed further between 1970 and 1990 in Germany, Switzerland, and the Netherlands. The development of FAE as psoriasis treatment did not follow the traditional drug development phases. Nonetheless, in 1994 FAE were approved in Germany for the treatment of severe plaque psoriasis. FAE are currently one of the most commonly used treatments in Germany, and FAE are increasingly being used as an unlicensed treatment in several other European countries. To date, six randomized controlled trials and 29 observational studies have evaluated FAE in a combined total of 3,439 patients. The efficacy and safety profile of FAE is favorable. About 50%–70% of patients achieve at least 75% improvement in psoriasis severity after 16 weeks of treatment. Common adverse events of FAE include gastrointestinal complaints and flushing symptoms, which lead to treatment discontinuation in up to 40% of patients. Lymphocytopenia, eosinophilia, and proteinuria are commonly observed during FAE treatment, but rarely require treatment discontinuation. The long-term safety profile of continuous FAE treatment is favorable without an increased risk for infections, malignancies, or other serious adverse events. There are no known drug-interactions for FAE. The 2009 European evidence-based S3-guidelines on psoriasis treatment recommend FAE and suggest it as a first-line systemic treatment for moderate-to-severe plaque psoriasis. This review is aimed to give an overview of FAE treatment in the management of psoriasis.

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Organising pneumonia associated with fumaric acid ester treatment for psoriasis

Cited by 12 publications

References 14 publications

Efficacy, effectiveness and safety of fumaric acid esters in the treatment of psoriasis: a systematic review of randomized and observational studies

Efficacy, effectiveness and safety of fumaric acid esters in the treatment of psoriasis: a systematic review of randomized and observational studies

Concomitant Interstitial Lung Disease with Psoriasis

Fumaric acid esters in the management of psoriasis

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