Use of Adalimumab in Treatment of Autoimmune Sensorineural Hearing Loss: A Word of Caution

Conway, Richard; Khan, Sameer; Foley-Nolan, Darragh

doi:10.3899/jrheum.100593

Cited by 13 publications

(6 citation statements)

References 4 publications

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“…A single case suggesting the benefit of adalimumab in conjunction with MTX for the control of AIED [59] was challenged by two reports of de novo AIED associated with this monoclonal antibody [78].…”

Section: Cytokine Modulationmentioning

confidence: 99%

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

2013

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Autoimmune sensorineural hearing loss (SNHL) is a rare clinical entity characterized by a progressive fluctuating bilateral asymmetric SNHL that develops over several weeks to months. Vestibular symptoms, tinnitus and aural fullness are present in up to 50% of patients. Due to the lack of specific diagnostic tests, both clinical suspicion and responsiveness to corticosteroids are the pillars for the diagnosis of autoimmune SNHL. The evaluation of patients in whom this condition is suspected should include a detailed history and physical examination, an audiogram, an MRI and a limited laboratory workup to exclude secondary causes of hearing loss. The low frequency of this condition, the heterogeneity in the designs of the available studies and the absence of randomized trials comparing treatment responses and assessing long-term outcomes are some of the factors accounting for the limited evidence to guide the clinician in the approach to the diagnosis and treatment of autoimmune SNHL.

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Section: Cytokine Modulationmentioning

confidence: 99%

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

2013

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“…Thus, TNFα antibodies themselves may trigger neurological symptoms, which may include CS-like symptoms, as shown in cases treated with anti-TNFα for inflammatory diseases. 83 , 84 …”

Section: Multidisciplinary Approach To Treatment Of Csmentioning

confidence: 99%

Optimal management of Cogan’s syndrome: a multidisciplinary approach

D’Aguanno¹,

Ralli²,

Vincentiis³

et al. 2017

JMDH

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Cogan’s syndrome (CS) is a rare disorder characterized by nonsyphilitic interstitial keratitis (IK) and audio-vestibular symptoms. CS affects mainly young Caucasian adults, mostly during their first three decades of age, and may develop into typical and atypical variants. Typical CS manifests primarily with IK and hearing loss, whereas atypical CS usually presents with inflammatory ocular manifestations in association with audio-vestibular symptoms but mostly different Ménière-like symptoms and, more frequently, with systemic inflammation (70%), of which vasculitis is the pathogenic mechanism. CS is considered as an autoimmune- or immune-mediated disease supported mainly by the beneficial response to corticosteroids. Using well-developed assays, antibodies to inner ear antigens, anti-Hsp70, and antineutrophil cytoplasmic antibodies were found to be associated with CS. Corticosteroids represent the first line of treatment, and multiple immunosuppressive drugs have been tried with variable degrees of success. Tumor necrosis factor-alpha blockers and other biological agents are a recent novel therapeutic option in CS. Cochlear implantation is a valuable rescue surgical strategy in cases with severe sensorineural hearing loss unresponsive to intensive and/or innovative immunosuppressive regimens.

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“…Alternative immunosuppressant therapies have not been well studied and many (e.g., cyclophosphamide) have serious toxicities that further complicate the benefit‐risk assessment. For some immunosuppressant agents, such as TNF‐blockers, there are reports of hearing loss as well as hearing improvement . Similarly, there is little evidence that other immunosuppressive agents help to maintain the response to corticosteroids.…”

Section: Steroidsmentioning

confidence: 99%

“…For some immunosuppressant agents, such as TNF-blockers, there are reports of hearing loss as well as hearing improvement. 52 Similarly, there is little evidence that other immunosuppressive agents help to maintain the response to corticosteroids. Methotrexate was studied in a multicenter, randomized, double-blind, placebo-controlled trial involving patients with bilateral AIED who had an initial response to prednisone therapy.…”

Section: Intratympanic Steroidsmentioning

confidence: 99%

Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy

et al. 2017

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Among various forms of hearing loss, there are acute (within 72 hrs) or subacute (weeks to months) presentations that may be reversible with early pharmacological intervention. The workup of a patient presenting with hypoacusia includes the usual history and physical examination in conjunction with an audiometric assessment in order to categorize the hearing loss as conductive, sensorineural, or mixed. Sudden sensorineural hearing loss and autoimmune inner ear disease are acute and subacute forms of sensorineural hypoacusia most likely to be reversed with prompt pharmacological intervention. Systemic or local corticosteroid therapy has the most evidence of benefit in patients with sudden sensorineural hypoacusia and is the best available first line therapy noted in clinical practice guidelines. Alternative immunosuppressant therapies have not been well studied, and many have serious toxicities that further complicate the benefit-risk assessment. There are no randomized comparisons of corticosteroid dosing regimens that evaluated clinically important outcomes, so expert opinion must serve as the basis for dosing recommendations. Clinicians need to involve patients with hypoacusia in the shared decision-making process, since partial or complete reversal of hearing loss can have substantial quality-of-life implications for affected patients.

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Use of Adalimumab in Treatment of Autoimmune Sensorineural Hearing Loss: A Word of Caution

Cited by 13 publications

References 4 publications

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

Optimal management of Cogan’s syndrome: a multidisciplinary approach

Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy

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Use of Adalimumab in Treatment of Autoimmune Sensorineural Hearing Loss: A Word of Caution

Cited by 13 publications

References 4 publications

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

Autoimmune sensorineural hearing loss: the otology-rheumatology interface

Optimal management of Cogan&rsquo;s syndrome: a multidisciplinary approach

Evaluation and Treatment of Acute and Subacute Hearing Loss: A Review of Pharmacotherapy

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Optimal management of Cogan’s syndrome: a multidisciplinary approach