1. Paradoxical eruptions to targeted therapies in dermatology: A systematic review and analysis.
- Author
-
Murphy MJ, Cohen JM, Vesely MD, and Damsky W
- Subjects
- Antibodies, Cytokines, Humans, Interleukin-23, Retrospective Studies, Tumor Necrosis Factor-alpha, Dermatology, Psoriasis chemically induced, Psoriasis drug therapy
- 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., Competing Interests: Conflicts of interest Dr Vesely's spouse is employed by Regeneron. Dr Damsky is a consultant for Eli Lilly, has received research funding from Pfizer, and receives licensing fees from EMD/Sigma/Millipore in unrelated work. Author Murphy and Dr Cohen have no conflicts of interest to declare., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF