Ko Justin M, Gottlieb Alice B, Kerbleski Joseph F
Department of Dermatology,Tufts Medical Center, Boston, Massachusetts, USA.
J Dermatolog Treat. 2009;20(2):100-8. doi: 10.1080/09546630802441234.
There are reports of rare adverse effects of tumor necrosis factor (TNF) inhibitors, including infections, malignancies, and induction of autoimmune conditions. Intriguing, are cases of induction or exacerbation of psoriasis in conjunction with TNF inhibitor therapy, given that they are approved for treatment of the same condition.
Published cases of psoriasis occurring during anti-TNF therapy were analyzed, including overviews of proposed etiologies and treatment recommendations.
A literature search using Ovid MEDLINE and PubMed was performed for articles published between January 1990 and September 2007 to collect reported cases of psoriasis in patients receiving therapy with TNF blocking agents.
A total of 127 cases were identified: 70 in patients on infliximab (55.1%), 35 with etanercept (27.6%), and 22 with adalimumab (17.3%). Females comprised 58% of cases; mean age of reported patients was 45.8 years, and the time from initiation of treatment to onset of lesions averaged 10.5 months. These patients suffered from a number of primary conditions, with rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease accounting for the vast majority. Palmoplantar pustular psoriasis was observed in 40.5% of the cases, with plaque-type psoriasis in 33.1%, and other types comprising the remainder. Topical corticosteroids were the most commonly employed treatment modality but led to resolution in only 26.8% of cases in which they were employed solely. Switching to a different anti-TNF agent led to resolution in 15.4% of cases. Cessation of anti-TNF therapy with systemic therapy led to resolution in 64.3% of cases.
More information and cases are needed. Biopsies of TNF-blockade-induced lesions may reveal what cytokines and cell types drive the development of these lesions. Additionally, there is a need to develop an algorithm to treat this paradoxical side effect of therapy with TNF-blockers.
有报道称肿瘤坏死因子（TNF）抑制剂存在罕见的不良反应，包括感染、恶性肿瘤以及诱发自身免疫性疾病。有趣的是，有病例显示在使用TNF抑制剂治疗期间银屑病会被诱发或加重，鉴于这些药物被批准用于治疗相同病症。
分析抗TNF治疗期间发生银屑病的已发表病例，包括对推测病因的概述及治疗建议。
利用Ovid MEDLINE和PubMed进行文献检索，查找1990年1月至2007年9月期间发表的文章，以收集接受TNF阻断剂治疗患者中银屑病的报告病例。
共确定127例病例：英夫利昔单抗治疗患者70例（55.1%），依那西普治疗患者35例（27.6%），阿达木单抗治疗患者22例（17.3%）。女性占病例的58%；报告患者的平均年龄为45.8岁，从开始治疗到出现皮损的时间平均为10.5个月。这些患者患有多种原发性疾病，其中类风湿关节炎、强直性脊柱炎和克罗恩病占绝大多数。40.5%的病例观察到掌跖脓疱型银屑病，33.1%为斑块型银屑病，其余为其他类型。外用糖皮质激素是最常用的治疗方式，但仅单独使用时仅26.8%的病例得到缓解。换用不同的抗TNF药物使15.4%的病例得到缓解。停用抗TNF治疗并采用全身治疗使64.3%的病例得到缓解。
需要更多信息和病例。对TNF阻断诱导的皮损进行活检可能会揭示哪些细胞因子和细胞类型驱动了这些皮损的发展。此外，需要制定一种算法来治疗TNF阻滞剂治疗这种矛盾的副作用。
