Paradoxical reactions to biologicals in chronic inflammatory systemic diseases

Kremenevski, I; Sander, Oliver; Sticherling, Michael; Raithel, Martin

doi:10.3238/arztebl.m2022.0067

Cited by 12 publications

(9 citation statements)

References 110 publications

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“… 9 Alternatively, we may have observed a paradoxical reaction, an uncommon occurrence in which treatment with biologics intended to reverse disease can actually induce the disease. 10 Although the correlation may be simply coincidental, our report suggests clinicians carefully consider the treatment of patients with vitiligo who are receiving romosozumab and potentially other Wnt pathway activators. Additionally, our findings question the hypothesis that Wnt pathway activators are beneficial to treat vitiligo.…”

Section: Discussionmentioning

confidence: 80%

Vitiligo progression in a patient undergoing romosozumab treatment for osteoporosis

Trepanowski,

Yim,

Wetstone

et al. 2023

JAAD Case Reports

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Section: Discussionmentioning

confidence: 80%

Vitiligo progression in a patient undergoing romosozumab treatment for osteoporosis

Trepanowski,

Yim,

Wetstone

et al. 2023

JAAD Case Reports

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“…When a drug that is approved for treatment induces the opposite of what is intended, such as a recurrence of inflammation or exacerbation of a predisposed disease, it is referred to as a paradoxical reaction 17 . The paradoxical response to treatment has been reported in patients with other mycoses 18 .…”

Section: Discussionmentioning

confidence: 99%

Severe form of lymphocutaneous sporotrichosis: a case report

Martins,

Durães,

Teixeira

et al. 2023

Rev. Inst. Med. trop. S. Paulo

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Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. It is caused by species of the genus Sporothrix. Infection in humans occurs through the entry of the fungus into the skin. Zoonotic outbreaks involving cats in the transmission of the disease have been frequently reported. The lymphocutaneous form is the most commonly observed and the upper limbs are the most affected sites. We report a case of a 64-year-old healthy female patient with a lymphocutaneous form with rapid progression of lesions, which was refractory to initial treatment with itraconazole. Treatment with liposomal amphotericin B was performed with a satisfactory resolution, but aesthetic and functional sequelae in the left upper limb were installed.

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“…Options to be considered for managing PRs include continuation of the biologic drug if the PR is mild, topical treatment and/or ultraviolet phototherapy for mild psoriasis, the addition of conventional synthetic DMARDs (e.g., glucocorticosteroids, methotrexate), and replacement of the offending drug with another class of immunomodulatory drugs such as TNF inhibitors, IL-17 inhibitors, IL12-23 inhibitor, or JAK inhibitors. Switching within the same class carries a risk of recurrence and, therefore, is best avoided [ 22 , 25 ]. Further research with a large number of patients may shed some light on the best management strategies for such cases.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Psoriasis and Worsening Spondylitis Due to Secukinumab in a Patient With Ankylosing Spondylitis: A Case Report and Literature Review

Alnaqbi,

Al Zeyoudi,

Fazal

et al. 2023

Cureus

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Axial spondyloarthritis (axSpA) is an autoimmune disease primarily affecting the axial skeleton, with associated extra-musculoskeletal manifestations. Treatment strategies targeting cytokines tumor necrosis factor-alpha (TNF-α) and interleukin 17 (IL-17) have proven effective. However, paradoxical reactions, including paradoxical psoriasis and arthritis, have been reported in axSpA patients receiving TNF-α inhibitors. IL-17 inhibitors have been used as an alternative treatment option, but paradoxical reactions have also been rarely observed. This case report presents a 45-year-old man with axSpA who responded to infliximab for six years before discontinuing it due to secondary failure. After the washout period of infliximab, he was started on secukinumab but developed paradoxical psoriasis and worsening of inflammatory back pain after receiving the second loading dose which necessitated replacing it with upadacitinib. Complete resolution of paradoxical psoriasis and significant improvement in his back pain after three months ensued. This case contributes to understanding the complex dynamics in treating axSpA and managing paradoxical reactions.

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Paradoxical reactions to biologicals in chronic inflammatory systemic diseases

Cited by 12 publications

References 110 publications

Vitiligo progression in a patient undergoing romosozumab treatment for osteoporosis

Vitiligo progression in a patient undergoing romosozumab treatment for osteoporosis

Severe form of lymphocutaneous sporotrichosis: a case report

Paradoxical Psoriasis and Worsening Spondylitis Due to Secukinumab in a Patient With Ankylosing Spondylitis: A Case Report and Literature Review

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