As Use of Biologicals Rises, So Too Will Cutaneous Reactions to Them: Presented

[Guest guest]

As Use of Biologicals Rises, So Too Will Cutaneous Reactions to

Them: Presented at AAAAI

DG News*

By Maggie Schwarz

http://www.docguide.com/news/content.nsf/news/852571020057CCF68525741

6004FF97B

PHILADELPHIA -- March 24, 2008 -- Serious cutaneous reactions to

biological agents are rare but can be expected to increase along

with use of these medications, according to a presentation made here

at the American Academy of Allergy, Asthma & Immunology (AAAAI)

Annual Meeting.

A. Gaspari, MD, Shapiro Professor and Chairman, Department

of Dermatology, University of land School of Medicine,

Collegeville, land, urged physicians to become familiar with

common and rare cutaneous toxicities of these agents, which are

being used increasingly to treat a variety of inflammatory and

autoimmune diseases, including rheumatoid arthritis, ankylosing

spondylitis, Crohn's disease, ulcerative colitis, and psoriasis.

Dr. Gaspari said that biologicals are also used off label for a

number of dermatological diseases. Nearly 1 billion patients have

been treated with infliximab, nearly 500,000 with etanercept, and

about 200,000 with adalimumab.

Dr. Gaspari said that quantification of toxicities of antitumor

necrosis factor (anti-TNF) agents is difficult because reporting is

anecdotal and hard to identify, comorbidities and concomitant

medications are often unreported, background rates of infection in

healthy and disease-affected populations are unknown, large

registries are in the process of being established, and no reliable

laboratory assessment of immunocompetency is available.

Anti-TNF-induced skin changes include possible hypersensitivity

reactions, autoimmune/immune dysfunction and miscellaneous skin

changes, Dr. Gaspari said in a workshop on March 15.

The incidence of injection-site reactions with etanercept in

clinical trials of patients with rheumatoid arthritis was 20% to

40%. The reactions are not dose limiting and incidence decreases

over time. With adalimumab, injection-site reactions are estimated

to occur in 20% of patients. These reactions are of concern because

they are likely mediated by immunoglobulin E (IgE) and IgE response

may increase over time, increasing the risk of anaphylaxis.

Vasculitis affects all age groups equally, can occur at any time,

and tends to occur on the lower extremities. Treatment of vasculitis

consists of corticosteroids and antihistamines, as well as

discontinuing the anti-TNF medication. The TNF inhibitor can be

restarted, Dr. Gaspari said.

Drug-induced systemic lupus erythematosus is also rare, has occurred

mostly in women in their 50s with rheumatoid arthritis, and almost

always resolves with discontinuation of the TNF inhibitor.

Disseminated and life-threatening fungal infections have been

reported with anti-TNF monotherapy and when combined with other

immunosuppressive medications.

Psoriasis has been reported with anti-TNF agents in patients without

prior psoriasis. Patients are female at a ratio of 3:1, and onset is

typically at more than 12 weeks of therapy.

Interstitial granulomatous dermatitis has also been reported, and it

is been remitted completely on withdrawal of the TNF inhibitor.

Dr. Gaspari concluded that, although injection-site reactions are

the most common cutaneous effects of biological agents and serious

cutaneous reactions are rare, physicians must become familiar with

common and rare toxicities of TNF inhibitors.

[Presentation title: Drug Eruptions From Biologics.]

[Guest guest]

Maggie,

Sorry to ask but could you possibly explain this briefly in lay-terms? I don't

yet have the background to follow this. As I have copd, I am sincerely

interested.

Many thanks,

> From: tigerpaw2c <tigerpaw2c@...>

> Subject: [] As Use of Biologicals Rises, So Too Will Cutaneous

Reactions to Them: Presented

>

> Date: Tuesday, March 25, 2008, 8:10 AM

> As Use of Biologicals Rises, So Too Will Cutaneous Reactions

> to

>

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