TNF-antagonist etanercept induced reversible posterior leukoencephalopathy syndrome

Kastrup, Oliver; Diener, Hans Christoph

doi:10.1007/s00415-008-0732-y

Cited by 32 publications

(11 citation statements)

References 11 publications

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“…Notably absent is anti-G D2 MoAb-mediated immunotherapy, despite a large published experience covering this treatment in children 9–21,25–30 and adults, 15,31–36 and despite case reports of PRES with MoAbs that are direct immunomodulators. 7,37,38 Anti-G D2 MoAbs trigger antibody-dependent cellular cytotoxicity and complement-mediated cytotoxicity, 39 but it remains to be determined if these anti-neoplastic mechanisms can predispose to PRES. 1–3 …”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody

Kushner

Modak

Basu

et al. 2013

Cancer

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Background Posterior reversible encephalopathy syndrome (PRES) comprises clinical and radiologic findings with rapid onset and potentially dire consequences. Patients experience hypertension, seizures, headache, visual disturbance, and/or altered mentation. Magnetic resonance imaging shows edematous changes in brain (especially parietal and occipital lobes). We report PRES associated with anti-GD2 monoclonal antibody (MoAb) immunotherapy which is now standard for high-risk neuroblastoma but has not previously been implicated in PRES. Methods Successive clinical trials using the anti-GD2 MoAb 3F8 for neuroblastoma patients involved multiple cycles of standard-dose 3F8 (SD-3F8) (20 mg/m2/day, x5 days/cycle) or two cycles of high-dose 3F8 (HD-3F8) (80 mg/m2/day, x5 days/cycle) followed by cycles of SD-3F8. Results PRES was diagnosed in 5/215 (2.3%) patients, including 3/160 (1.9%) patients receiving SD-3F8 and 2/55 (3.6%) patients receiving HD-3F8 (p=0.6). All five patients had a rapid return to clinical-radiologic baseline. PRES occurred in 3/26 (11.5%) patients whose prior treatment included external-beam radiotherapy to the brain (2/6 patients status-post total body irradiation plus 1/20 patients status-post craniospinal irradiation) compared to 2/189 (1.1%) patients without prior brain irradiation (p=0.01). Hypertension, which is strongly linked to PRES, reached grade 3 toxicity in 12/215 (5.6%) patients, including the five patients with PRES and seven patients without PRES. Conclusions Patients receiving anti-GD2 MoAb immunotherapy should be closely monitored for, and undergo urgent treatment or evaluation of, symptoms (e.g., hypertension or headaches) that might herald PRES. Prior brain irradiation may be a predisposing factor for PRES with this immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody

Kushner

Modak

Basu

et al. 2013

Cancer

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“…1 Dermatologists should be aware of the signs and symptoms of RPLS because the systemic medications cyclosporine 17,18 and methotrexate, 19,20 which are commonly used to treat psoriasis, have been associated with RPLS in patients with psoriasis. Furthermore, cases of RPLS have been reported in patients who were treated for disorders other than psoriasis with the anti-tumor necrosis factor biologic agents etanercept 22 and infliximab, 23,24 which are also approved for the treatment of psoriasis.…”

Section: Commentmentioning

confidence: 99%

“…The time to onset after the initial drug exposure in this case (2 1 ⁄2 years) is much longer than has been reported for other cases of drug-associated RPLS. The time to onset of RPLS typically ranges from hours (with intravenous immunoglobulin 39 ) to months (with, eg, cyclosporine, 17 tacrolimus, 40 and etanercept, 22 ) or even up to 1 year (with bevacizumab 41 ). The patient also achieved complete recovery despite still having steady state therapeutic serum levels of ustekinumab, suggesting that there could be additional or alternative mechanisms accounting for her developing RPLS.…”

Section: Commentmentioning

confidence: 99%

Reversible Posterior Leukoencephalopathy Syndrome in a Patient Treated With Ustekinumab

Gratton¹,

Szapary²,

Goyal³

et al. 2011

Arch Dermatol

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Background: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare, generally reversible neurologic syndrome that is diagnosed based on characteristic clinical and radiologic findings.Observations: We describe the first case of RPLS in a 65-year-old woman who underwent ustekinumab therapy for psoriasis. Approximately 2 1 ⁄2 years after the patient began ustekinumab therapy, she experienced an acute onset of confusion, headache, nausea, vomiting, and seizures. Computed tomographic scans and magnetic resonance images of her head revealed characteristic findings, including white matter abnormalities consistent with edema in the absence of infarction. There was no evidence of vasospasm, thrombosis, or infection. Cerebrospinal fluid tests were negative for the JC virus. The patient improved clinically and was discharged 6 days after she presented to the emergency department. She made a full neurologic recovery, with a reversal of the radiologic findings.Conclusions: Reversible posterior leukoencephalopathy syndrome is an increasingly recognized neurologic disorder that has been reported with the use of systemic and biologic agents to treat moderate to severe psoriasis. Although the relationship between RPLS and ustekinumab therapy remains unclear, this case emphasizes the need for dermatologists to recognize the syndrome's signs and symptoms and to refer patients promptly for evaluation and appropriate treatment if the clinical features of RPLS are suspected.

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“…In some cases, but not all, these syndromes have improved after withdrawal of TNFα blocking therapy and steroids were given. Accordingly, TNFα blocking therapy should not be given to patients with a history of demyelinating disease or optic neuritis (category D evidence348 349 350 351 352). …”

Section: Tnf Blocking Agentsmentioning

confidence: 99%

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009

Furst

Keystone

Fleischmann

et al. 2010

Annals of the Rheumatic Diseases

165

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TNF-antagonist etanercept induced reversible posterior leukoencephalopathy syndrome

Cited by 32 publications

References 11 publications

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody

Reversible Posterior Leukoencephalopathy Syndrome in a Patient Treated With Ustekinumab

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009

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TNF-antagonist etanercept induced reversible posterior leukoencephalopathy syndrome

Cited by 32 publications

References 11 publications

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐GD2 3F8 monoclonal antibody

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐GD2 3F8 monoclonal antibody

Reversible Posterior Leukoencephalopathy Syndrome in a Patient Treated With Ustekinumab

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009

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Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody

Posterior reversible encephalopathy syndrome in neuroblastoma patients receiving anti‐G_D2 3F8 monoclonal antibody