RESEARCH - TNF blockers may trigger skin lesions in some patients

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TNF blockers may trigger skin lesions in some patients

Rheumawire

Mar 9, 2006

Gandey

Berlin, Germany - Researchers are hypothesizing that tumor-necrosis-factor

(TNF) blockade may have the unexpected effect of prompting new-onset

psoriasis or aggravating existing disease [1]. Despite previous evidence

suggesting that TNF inhibitors significantly reduce psoriatic skin lesions,

senior author Dr Gerd-Rüdiger Burmester (Charité-University Medicine,

Berlin, Germany) and colleagues have published new preliminary findings

suggesting that the opposite may be true for some patients. Their work

appears in the March 2006 issue of the ls of the Rheumatic Diseases.

In a small case report, the researchers describe nine patients with

rheumatoid arthritis (RA) treated with different types of TNF antagonists

who unexpectedly developed psoriatic skin lesions. " The inhibition of TNF-

[may have] influenced the manifestation of psoriasis skin lesions in our

patients, " write the researchers, led by Dr Sonja Kary (Charité-University

Medicine). " As far as we know, this is the first demonstration of either a

new onset or an exacerbation of psoriatic skin lesions during anti-TNF-

treatment. "

The researchers report that an additional literature search revealed

sporadic information on psoriasis and psoriasislike symptoms in patients

treated with TNF blockers for inflammatory bowel disease, ankylosing

spondylitis, and RA.

They found that withdrawal or dose reduction of TNF-blocking agents led to

improvement only in some patients and was generally limited by the activity

of the underlying RA. A change within the substance class reduced the

severity of the symptoms in some patients, but the researchers found that

they could not predict which biological agent would prove to be less

harmful.

They looked at two monoclonal antibodies-infliximab (Remicade, Centocor) and

adalimumab (Humira, Abbott)-as well as the receptor construct etanercept

(Enbrel, Amgen/Wyeth). They note that all three TNF blockers have been shown

to be effective in psoriatic skin disease in clinical trials and etanercept

in particular has been approved for this indication.

Kary and colleagues note that a hypothetical explanation for the appearance

or deterioration of psoriasis might be the overall enhanced susceptibility

to bacterial infections caused by TNF inhibition, but, they point out, none

of the patients had a preceding bacterial infection.

The researchers contend that RA patients rarely present with psoriasis of

the skin. They point to the unpublished German national data bank for

rheumatological diseases, which shows that only 26 out of more than 11 400

patients with definite RA simultaneously had psoriasis.

The investigators conclude, " A study of such patients with new onset or

aggravation of psoriasis during TNF- blockade will be continued for further

analysis of an underlying common pattern. "

Source

1. Kary S, Worm M, Audring H, et al. New onset or

exacerbation of psoriatic skin lesions in patients with definite rheumatoid

arthritis receiving tumour necrosis factor alpha antagonists. Ann Rheum Dis

2006; 65:405-407.

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Mayo Clinic in Rochester

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s Hopkins Medicine

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