Practical Management of Immunosuppressants in Dermatology

Leis-Dosil, V.M.; Prats-Caelles, I.

doi:10.1016/j.adengl.2017.11.004

Cited by 3 publications

(2 citation statements)

References 71 publications

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“…40,64 Azathioprine is metabolized into 6-mercaptopurine (an active drug) that is incorporated into the cell DNA and antagonizes the synthesis of nucleic acids and proteins. 71,72 This results in cell cycle arrest and death, thus inhibiting lymphocyte proliferation and autoantibody production. 73 Mycophenolate mofetil is a prodrug of mycophenolic acid that inhibits de novo synthesis of guanine nucleotides, halting T-and B-cell proliferation.…”

Section: Evolution and Prognosismentioning

confidence: 99%

Paraneoplastic pemphigus: a clinical, laboratorial, and therapeutic overview

Maruta

Miyamoto

Aoki

et al. 2019

An. Bras. Dermatol.

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Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.

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Section: Evolution and Prognosismentioning

confidence: 99%

Paraneoplastic pemphigus: a clinical, laboratorial, and therapeutic overview

Maruta

Miyamoto

Aoki

et al. 2019

An. Bras. Dermatol.

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“…Conventional immunosuppressants such as corticosteroids, cyclosporine, methotrexate, or azathioprine present a significant burden of side effects (AEs) [ 1 ], including cytopenias (methotrexate or azathioprine), renal dysfunction or hypertension (cyclosporine), and an elevated incidence of cutaneous and extracutaneous neoplasms and opportunistic infections in patients undergoing long-term therapy [ 2 ]. Biologic drugs (BD) have revolutionized the management of multiple dermatoses [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Biologics Versus JAK Inhibitors. Part I: Cancer Risk. A Narrative Review

Mansilla-Polo,

Morgado-Carrasco

2024

Dermatol Ther (Heidelb)

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Introduction Biological drugs (BD) and Janus kinase inhibitors (JAKi) have revolutionized the treatment of diverse dermatoses. However, there are concerns regarding their safety, especially the risk of cancer and opportunistic infections. Here, we discuss the risk of cancer associated with the BD and JAKi used in dermatology. Methods A narrative review was carried out. All relevant articles evaluating the risk of cancer associated with BD or JAKi and published between January 2010 and February 2024 were selected. Results Multiple large studies have evaluated the association between BD, JAKi and cancer risk. However, there is a lack of prospective, comparative studies. Overall, patients undergoing BD and JAKi present a cutaneous cancer incidence similar to that in the general population. The drugs more strongly associated with non-skin cancer risk were anti-tumor necrosis factor (anti-TNFs) agents and JAKi (especially tofacitinib and oral ruxolitinib). This risk appears to increase with age, the presence of other factors (such as chronic immunosuppression from previous drugs or other comorbidities), and specific diseases such as rheumatoid arthritis (RA) and myelodysplastic syndrome. Conversely, BD such as interleukin (IL)-17 and IL-23 inhibitors may even reduce the risk of some visceral and hematological malignancies. In patients with dermatological conditions such as psoriasis and atopic dermatitis, the risk of malignancies may be lower than in other subgroups, and probably comparable to the general population. Conclusions The incidence of cancer in patients undergoing BD or JAKi is generally low. This incidence can be higher in elderly patients with RA or myelodysplastic syndrome, and in those undergoing prolonged therapy with tofacitinib or ruxolitinib (oral), or anti-TNF agents.

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