Prolongierte Psoriasistherapie mit TNF-α-Antagonisten

Kowalzick, L.; Eickenscheidt, L.; Komar, Michael; Schaarschmidt, E.

doi:10.1007/s00105-008-1695-8

Cited by 26 publications

(9 citation statements)

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“…Case reports and a recent meta-analysis have suggested an association between biologic anti-TNF medications and risk of melanoma. 14–16 Defining the risk of melanoma in patients with IBD is paramount, because preventive measures (such as sunscreen use) have been shown to reduce the incidence of melanoma. 17 …”

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confidence: 99%

Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

et al. 2012

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BACKGROUND & AIMS Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks. METHODS We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers. RESULTS In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09–1.53). Risk was greatest among individuals with Crohn’s disease (IRR, 1.45; 95% CI, 1.13–1.85; adjusted HR, 1.28; 95% CI, 1.00–1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40–1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54–1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08–3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66–2.05). CONCLUSIONS Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.

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Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

et al. 2012

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“…But before biologics the patient became treatment with fumarates, cyclosporine A, methotrexate, and cream PUVA and UVB. Due to the fact that many patients received different treatment before biological treatment, it is hard to conclude that biological treatment was the only root cause for melanoma [20] .…”

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confidence: 99%

Clinical and dermoscopic features of nevi in patients with psoriasis

Glebovna

Mihailovna

Viktorovich³

et al. 2017

J Surg Dermatol

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The aim of the present study is to display the clinical and dermoscopic features of melanocytic nevi of more than 5 mm in diameter in psoriasis patients. A total of 32 patients with psoriasis (21 male, 11 female; average age 37.4) formed the first study group. In 22 patients (68.8%), melanocytic nevi of 5 mm in diameter and bigger (total of 68 nevi) were clinically found. For a randomized trial, 100 people (21 male, 79 female; average age 27.8) without psoriasis were invited to form the second study group. Only 37 of them had nevi ≥5 mm in diameter (total of 60 nevi). Complete questionnaire, full body photometric skin examination, dermoscopy examination on the dermatoscope HEINE MINI 10X with 70% ethyl alcohol immersion, skin type identification according to the Fitzpatrick classification, and nevi assessment according to ABCD and ABC rules were obtained for all recruited people. Our study showed that patients with psoriasis are more susceptible to melanocytic nevi of >5 mm in diameter (68.8%), while the result for the second group was 37%. As for nevi of dysplastic criteria, we found 32% in psoriasis patients vs. 42% in the monitoring group. Moreover, we should bear in mind the influencing factors of skin phototype II and artificial insolation (e.g., tanning, PUVA (Psoralen and ultraviolet A), and narrowband phototherapy 311 nm) obtained by the patients from the first group.

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“…Gordon et al29 reported a case of primary MM in a patient receiving adalimumab for PS. Kowalzick et al30 reported the occurrence of MM in a patient treated consecutively with infliximab, adalimumab, and etanercept for PS. Khan et al31 reported another case of primary MM in a patient treated with infliximab for RA.…”

Section: Discussionmentioning

confidence: 99%

Development of primary malignant melanoma during treatment with a TNF-α antagonist for severe Crohn’s disease: a case report and review of the hypothetical association between TNF-α blockers and cancer

Kouklakis¹,

Efremidou²,

Pitiakoudis³

et al. 2013

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It is recognized that immunosuppression may lead to reduced immune surveillance and tumor formation. Because of the immunosuppressive properties of tumor necrosis factor (TNF)-alpha (TNF-α) antagonists, it is plausible that these biologics may increase the risk of the occurrence of malignancies or the reactivation of latent malignancies. TNF-α antagonists have gained momentum in the field of dermatology for treating rheumatoid arthritis and psoriasis, and they have revolutionized the treatment of other inflammatory autoimmune diseases such as refractory Crohn’s disease. However, there is accumulating evidence that TNF-α inhibitors slightly increase the risk of cancer, including malignant melanoma (MM). The authors herein report the case of a 54-year-old female patient who developed a primary MM during treatment with adalimumab for severe Crohn’s disease resistant to successive medical therapies. The patient had been receiving this TNF-α blocker therapy for 3 years before the occurrence of MM. After wide surgical excision of the lesion and staging (based on Breslow thickness and Clark level), evaluation with a whole-body computed tomography scan was negative for metastatic disease. The long duration of the adalimumab therapy and the patient’s lack of a predisposition to skin cancer suggest an association between anti-TNF-α drugs and melanocytic proliferation. The authors also review the literature on the potential association between anti-TNF regimens and the occurrence of malignancies such as melanocytic proliferations. There is a substantial hypothetical link between anti-TNF-α regimens such as adalimumab and the potential for cancers such as melanoma. However, the risk of malignancy with biological therapy remains to be established, and most of the relevant studies have lacked the statistical power and randomization required for large clinical trials. Further long-term controlled clinical trials and registries are required to investigate this potentially serious association.

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Prolongierte Psoriasistherapie mit TNF-α-Antagonisten

Cited by 26 publications

References 9 publications

Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

Clinical and dermoscopic features of nevi in patients with psoriasis

Development of primary malignant melanoma during treatment with a TNF-α antagonist for severe Crohn’s disease: a case report and review of the hypothetical association between TNF-α blockers and cancer

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Prolongierte Psoriasistherapie mit TNF-α-Antagonisten

Cited by 26 publications

References 9 publications

Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

Clinical and dermoscopic features of nevi in patients with psoriasis

Development of primary malignant melanoma during treatment with a TNF-&alpha; antagonist for severe Crohn&rsquo;s disease: a case report and review of the hypothetical association between TNF-&alpha; blockers and cancer

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Development of primary malignant melanoma during treatment with a TNF-α antagonist for severe Crohn’s disease: a case report and review of the hypothetical association between TNF-α blockers and cancer