Document Detail


Vasculitis associated with tumor necrosis factor-α inhibitors.
MedLine Citation:
PMID:  22795634     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the clinical characteristics, histopathologic features, and outcomes of patients in whom vasculitis developed in association with use of tumor necrosis factor-α (TNF-α) inhibitors.
PATIENTS AND METHODS: This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced by anti-TNF-α therapy.
RESULTS: Of 8 patients with vasculitis associated with anti-TNF-α therapy (mean age, 48.5 years), 6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease, and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%) with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before development of vasculitis was 34.5 months. The skin was the predominant organ affected (5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4 of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were histopathologically confirmed. Seven of 8 patients improved with discontinuation of therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received prednisone; another agent was also used in 7); rechallenge with anti-TNF-α therapy was not attempted in any patient. At last follow-up, no patients had experienced a recurrence of vasculitis after therapy discontinuation.
CONCLUSION: Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis, including peripheral nerve and renal vasculitis, was also frequently observed.
Authors:
Olayemi Sokumbi; David A Wetter; Ashima Makol; Kenneth J Warrington
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Publication Detail:
Type:  Journal Article     Date:  2012-07-13
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  87     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-06     Completed Date:  2012-10-24     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  739-45     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Inflammatory Agents / adverse effects*
Antibodies, Monoclonal / adverse effects*
Antibodies, Monoclonal, Humanized / adverse effects
Antibodies, Monoclonal, Murine-Derived / therapeutic use
Arthritis, Rheumatoid / drug therapy
Azathioprine / therapeutic use
Colitis, Ulcerative / drug therapy
Crohn Disease / drug therapy
Cyclophosphamide / therapeutic use
Female
Glucocorticoids / therapeutic use
Hematuria / etiology
Humans
Immunoglobulin G / adverse effects
Immunologic Factors / therapeutic use
Male
Methotrexate / therapeutic use
Middle Aged
Mycophenolic Acid / analogs & derivatives,  therapeutic use
Polyneuropathies / etiology
Prednisone / therapeutic use
Proteinuria / etiology
Receptors, Tumor Necrosis Factor
Retrospective Studies
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Vasculitis / chemically induced*,  drug therapy
Young Adult
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Monoclonal, Murine-Derived; 0/Glucocorticoids; 0/Immunoglobulin G; 0/Immunologic Factors; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 0/infliximab; 0/rituximab; 185243-69-0/TNFR-Fc fusion protein; 8N3DW7272P/Cyclophosphamide; 9242ECW6R0/mycophenolate mofetil; FYS6T7F842/adalimumab; HU9DX48N0T/Mycophenolic Acid; MRK240IY2L/Azathioprine; VB0R961HZT/Prednisone; YL5FZ2Y5U1/Methotrexate
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