Successful Treatment of Autoimmune Disease–Associated Pyoderma Gangrenosum With the IL-1 Receptor Antagonist Anakinra

Beynon, Celia; Chin, Mei Fong; Hunasehally, Prasad; Bhagwandas, Krishnan; Bevan, Martin A.; Taylor, Marisa; Lawson, Thomas

doi:10.1097/rhu.0000000000000511

Cited by 29 publications

(23 citation statements)

References 8 publications

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“…A total of 3212 unique citations were found. 1286 and 1704 citations were excluded by abstract and full‐text read, respectively, yielding 222 articles…”

Section: Resultsmentioning

confidence: 99%

Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

Abdallah

Fogh

Bech

2019

International Wound Journal

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Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that presents a therapeutic challenge. Tumour necrosis factor alpha (TNFα) inhibitors have been reported to successfully control PG. Our aim was to systematically evaluate and compare the clinical effectiveness of TNFα inhibitors in adults with PG. A literature search including databases such as PubMed, Embase, Scopus, and Web of Science was conducted, using search terms related to PG and TNFα inhibitors. Studies and case reports were included if patients were diagnosed with PG, over the age of 18 and administered TNFα inhibitor. A total of 3212 unique citations were identified resulting in 222 articles describing 356 patients being included in our study. The study we report found an 87% (95% CI: 83%‐90%) response rate and a 67% (95% CI: 62%‐72%) complete response rate to TNFα inhibitors. No statistically significant differences in the response rates (P = 0.6159) or complete response rates (P = 0.0773) to infliximab, adalimumab, and etanercept were found. In our study TNFα inhibitors demonstrated significant effectiveness with response and complete response rates supporting the use of TNFα inhibitors to treat PG in adults. Our study suggests that there is no significant difference in effectiveness among infliximab, adalimumab, and etanercept.

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“…A total of 3212 unique citations were found. 1286 and 1704 citations were excluded by abstract and full‐text read, respectively, yielding 222 articles…”

Section: Resultsmentioning

confidence: 99%

Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

Abdallah

Fogh

Bech

2019

International Wound Journal

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“…Although the pathogenesis of PG is not well understood, in our patient the cytoskeletal defects might have induced the initial formation of ulcerative lesions. Anakinra is a recombinant circulating IL-1 receptor antagonist which has been successfully used to treat auto-inflammatory diseases, which are characterized by aberrant activation of the IL-1 pathway (Beynon et al, 2017). In our case, the additional immunosuppressive effect of anti-IL-1 treatment in an immunodeficient patient could have increase the risk of complications.…”

mentioning

confidence: 88%

Retracted: Successful treatment of pyoderma gangrenosum with anakinra in a patient with Wiskott–Aldrich syndrome

Mercuri

Paolino

Flammineis

et al. 2017

Dermatologic Therapy

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“…These results were all superior to corticosteroids (48.8%; n = 78) (49). Anakinra and canakinumab lead to variable outcomes (50, 51).…”

Section: Neutrophilic Disorders: Pyoderma Gangrenosum (Pg)mentioning

confidence: 99%

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

2019

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The impressive potential of biologics has been demonstrated in psoriasis, hidradenitis suppurativa, and urticaria. Numerous biologicals are entering the field for a restricted number of skin disorders. Off-label use of biologics in other recalcitrant skin diseases has increased. Mounting data point to the potential of already existing biologics acting on the IL-17/IL-23 pathway in skin disorders with epidermal hyperkeratosis (e.g., pityriasis rubra pilaris), acneiform inflammation (e.g., hidradenitis suppurativa), and loss of mucosal integrity (e.g., aphthosis). TNF-α blockers are also effective in the latter conditions but seem of particular value in granulomatous (e.g., granuloma annulare) and neutrophilic disorders (e.g., pyoderma gangrenosum). Failure of IL-17 blockade in skin diseases resulting from immune-mediated cell destruction (e.g., alopecia areata and vitiligo) illustrates its limited involvement in Th1-dependent skin immunology. Overall, disappointing results of TNF-α blockers in alopecia areata and vitiligo point to the same conclusion although promising results in toxic epidermal necrolysis suggest TNF-α exerts at least some in vivo Th1-related activities. Acting on both the Th1 and Th17 pathway, ustekinumab has a rather broad potential with interesting results in lupus and alopecia areata. The efficacy of omalizumab in bullous pemphigoid has revealed an IgE-mediated recruitment of eosinophils leading to bullae formation. Reconsidering reimbursement criteria for less common but severe diseases seems appropriate if substantial evidence is available (e.g., pityriasis rubra pilaris). For other disorders, investigator-and industry-initiated randomized clinical trials should be stimulated. They are likely to improve patient outcome and advance our understanding of challenging skin disorders.

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Successful Treatment of Autoimmune Disease–Associated Pyoderma Gangrenosum With the IL-1 Receptor Antagonist Anakinra

Cited by 29 publications

References 8 publications

Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

Retracted: Successful treatment of pyoderma gangrenosum with anakinra in a patient with Wiskott–Aldrich syndrome

Learning From Success and Failure: Biologics for Non-approved Skin Diseases

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