Vasculitides induced by TNFα antagonists: a study in 39 patients in France

Marcoux, Bernadette Saint; Bandt, M. De

doi:10.1016/j.jbspin.2006.02.010

Cited by 166 publications

(105 citation statements)

References 10 publications

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“…A French survey-based registry of TNFa inhibitor AAV found it in 39 of 1200 patients, five of whom were ANCA positive (51). Another prospective series of patients with ankylosing spondylitis did not show a significant increase in ANCA seroconversion in treated patients (52).…”

Section: Drugs Associated With Aavmentioning

confidence: 99%

Drug-Induced Glomerular Disease

Hogan

Markowitz²,

Radhakrishnan

2015

Clinical Journal of the American Society of Nephrology

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Drug-induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupus-like syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Over the years, multiple other agents have been linked to immune-mediated glomerular disease, often with associated autoantibody formation. Certain clinical and laboratory features may distinguish these entities from their idiopathic counterparts, and making this distinction is important in the diagnosis and management of these patients. Here, drug-induced, ANCA-associated vasculitis, drug-induced lupus, and drug-associated membranous nephropathy are reviewed.

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Section: Drugs Associated With Aavmentioning

confidence: 99%

Drug-Induced Glomerular Disease

Hogan

Markowitz²,

Radhakrishnan

2015

Clinical Journal of the American Society of Nephrology

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“…Secondly, in some patients treated with etanercept, the skin lesions started at the injection site and spread to involve other areas of the body, supporting a role for a direct antigen-mediated hypersensitivity vasculitis. Thirdly, even though patients were reported to IgA deposits (n=2) or active floccular necrosis against a background of glomerular sclerosis (n=1) [18].…”

Section: Discussionmentioning

confidence: 99%

Adalimumab induced chronic interstitial nephritis: a controlled blinded trial in mice

Mogairen¹

2017

ISSN 1758-4272 Int. J. Clin. Rheumatol

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“…Withdrawal of the drug-induced vasculitis and administration of steroid and anti-histamines is usually associated with good outcomes. In literature, six of nine patients experienced rechallenge of the vasculitis after anti-TNF readministration [6]. Since our patient developed respiratory distress in addition to cutaneous induced side effect we opted for changing the type of the biological treatment.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Vasculitis Induced by Etanercept and Tocilizumab

Induced¹,

Tocilizumab²

2016

J Clin Case Rep

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Biological disease modifying anti-rheumatic drugs (bDMARDs) have improved outcome of rheumatoid arthritis (RA). Tocilizumab (TCZ) is a monoclonal humanized anti-interleukin-6 receptor (IL6-R) which is indicated in case of inadequate response to one or more DMARDs or other biological treatment. Vasculitis has been reported with anti-TNF (Tumor Necrosis Factor) agents among more than 140 cases according to the BIOGEAS study group ( a Study Group on Autoimmune Diseases of the Spanish Society of Internal Medicine) but only in two cases with TCZ. We report the first case of cutaneous vasculitis occurring under both anti-TNF therapy and TCZ. Keywords:Cutaneous vasculitis; Anti-rheumatic drugs; Autoimmune diseases Case ReportA 60-year-old woman was followed-up for seropositive and erosive RA fulfilling ACR 1987 criteria's. She was initially treated by methotrexate then associated to sulfasalazine without any significant benefits. Leflunomide was introduced for a period of 4 months with a prompt response. However, a generalized cutaneous rash appeared two weeks after initiating this treatment and disappeared at interruption. The patient was treated by infliximab (3 mg/kg/8weeks) with a good initial response because of active disease; methotrexate was maintained (10 mg/week). Then a secondary failure was observed although rising dose treatment and shortening time between perfusions (5 mg/kg/ 6weeks). After 7 months, we switched to etanercept (ETN) 50 mg/ week. At the third week of treatment, the patient noticed a cutaneous ecchymotic rash of her legs, appearing few hours after the injection and disappearing spontaneously. She was hospitalized after 8 weeks of treatment, no skin lesions were found and the disease remains active. Ninth ETN injection was administrated under close monitoring. So she developed the same lesions described and respiratory distress. Steroids were administrated with a good outcome. Since a major averse effect occurred under anti-TNF therapy we decided to switch the biological agent to TCZ (8 mg/kg/4weeks). After the second perfusion, identical skin lesion she acquired under ETN occurred, appeared few hours after infusion and cleared one week later (Figure1). A skin biopsy was performed showing leucocytoclasic vasculitis with a perivascular inflammatory infiltration. Laboratory tests showed normal peripheral eosinophil and lymphocyte counts. Test for antinuclear antibodies, Antineutrophil cytoplasmic antibody (ANCA) and cryoglobulinemia were negative. Complement levels were normal. TCZ was associated with a good response for RA activity. Considering cutaneous vasculitis as a minor side effect and after discussion with the patient and pharmacovigilance expert, we decided to continue this therapy with tight control. Every infusion was preceded with antihistamine drugs and steroid pulse. Till this day, the patient has received 7 perfusions. Skin lesions still appear at the same time and in the same places and disappear soon without others cutaneous or respiratory outcomes. DiscussionCutaneous...

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Vasculitides induced by TNFα antagonists: a study in 39 patients in France

Cited by 166 publications

References 10 publications

Drug-Induced Glomerular Disease

Drug-Induced Glomerular Disease

Adalimumab induced chronic interstitial nephritis: a controlled blinded trial in mice

Cutaneous Vasculitis Induced by Etanercept and Tocilizumab

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