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Leukocytoclastic vasculitis associated with tumor necrosis factor-alpha blocking agents
Niveditha Mohan1, Evelyne T Edwards, Thomas R Cupps
1Avera Research Institute, Sioux Falls, South Dakota 57105, USA. nmohan@pol.net
The Journal of Rheumatology
|October 7, 2004
Summary
Tumor necrosis factor-alpha (TNF-alpha) blockers like etanercept and infliximab may cause leukocytoclastic vasculitis (LCV). Discontinuing TNF-alpha therapy often improves LCV skin lesions, but other causes should be ruled out.
Area of Science:
- Rheumatology
- Dermatology
- Immunology
Background:
- Tumor necrosis factor-alpha (TNF-alpha) blockers are widely used for inflammatory conditions.
- Adverse drug reactions, including vasculitis, can occur with biologic therapies.
Purpose of the Study:
- To investigate the association between TNF-alpha blocker use and leukocytoclastic vasculitis (LCV).
- To describe the clinical features and outcomes of LCV in patients treated with TNF-alpha inhibitors.
Main Methods:
- Retrospective analysis of the FDA Adverse Events Reporting System (AERS).
- Inclusion of patients who developed LCV after etanercept or infliximab initiation.
- Review of biopsy-proven and clinically diagnosed LCV cases.
Main Results:
- 35 cases of LCV were identified (20 etanercept, 15 infliximab).
- 48.5% of cases were biopsy-proven.
- 62.8% of patients showed improvement after stopping TNF-alpha blockers.
- Positive rechallenge was observed in 6 patients.
Conclusions:
- TNF-alpha blocking agents may be associated with LCV development.
- Discontinuation of anti-TNF-alpha therapy generally leads to improvement of skin lesions.
- Exclusion of other LCV causes and assessment for systemic involvement are recommended.