Paradoxical eruptions to targeted therapies in dermatology: A systematic review and analysis - 22/01/21
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Abstract |
Background |
Antibody-based therapies that inhibit proinflammatory cytokine signaling are commonly used in dermatology. Paradoxically, these medications may induce or exacerbate inflammatory disorders.
Objective |
To summarize the spectrum of manifestations, incidence, timing, potential mechanisms of, and general management approaches to paradoxical cutaneous reactions induced by cytokine-targeted antibodies in dermatology.
Methods |
We performed a systematic review and analysis of published cases of cutaneous paradoxical reactions (PRs) reported in association with tumor necrosis factor α, interleukin (IL) 12/23 (p40), IL-17A/17R, IL-23 (p19), and IL-4Rα inhibitors.
Results |
We identified 313 articles reporting 2049 cases of PRs. Tumor necrosis factor α inhibitors resulted in 91.2% (1869/2049) of all cases, followed by IL-17/17R (3.5%), IL-4Rα (2.7%), IL-12/23 (2.4%), and IL-23 (0.01%) inhibitors. Psoriasiform and eczematous eruptions were the most commonly reported, but a wide spectrum of patterns were described. Phenotypically overlapping reaction patterns were common. Time to onset typically ranged from weeks to months but could occur more than a year later. Improvement or resolution upon discontinuation of the inciting drug was common.
Limitations |
This was a retrospective analysis.
Conclusions |
Familiarity with the clinical features of PRs from cytokine-blocking antibodies may facilitate efficient recognition and management.
Le texte complet de cet article est disponible en PDF.Key words : dupilumab, IL-17 inhibitor, IL-23 inhibitor, lupus, paradoxical eruption, paradoxical psoriasis, psoriasis, sarcoidosis, TNF-alpha inhibitor, ustekinumab
Abbreviations used : AD, ADAb, ANA, E-PR, IBD, IL, L-PR, mAb, P-PR, PR, S-PR, Th, TNF, TNFai
Plan
Funding sources: Drs Vesely and Damsky and are supported by Career Development Awards from the Dermatology Foundation. |
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IRB approval status: Not applicable. |
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Reprints not available from the authors. |
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