Top anti-arthritis drugs cause skin disease

Members of the second most important family of drugs used to treat rheumatoid
arthritis can cause serious dermatological conditions in a quarter of patients
under treatment, reveals a study published today in the journal Arthritis
Research and Therapy.


Last year saw the withdrawal of frontline anti-arthritis drug Vioxx, which
belongs to the cox-2 inhibitors family, when it was revealed that it poses a
significant risk of heart attack and stroke. Similar findings were reported for
other cox-2 inhibitors, although they are still on the market. This study shows
that another family of anti-arthritis drugs, Tumour Necrosis Factor alpha
(TNF-alpha) blocking agents, trigger skin conditions in 25% of patients
undergoing treatment. TNF-alpha blocking agents are used to halt the process of
joint destruction in patients with severe arthritis conditions.


In the first study of the kind Marcel Flendrie and colleagues, from Radboud
University Nijmegen Medical Centre in the Netherlands, followed a population of
289 patients who had been undergoing treatment for rheumatoid arthritis with
TNF-alpha blocking drugs for a period of one to ten years. The drugs the
patients had been taking included two anti-TNF-alpha antibodies, infliximab and
adalimumab, and the TNF-alpha receptors etanercept and lenercept.


The results of the study show that 25% of patients on therapy suffered from a
dermatological condition that led them to visit a skin specialist. In a control
group of patients who were not undergoing TNF-alpha blocking therapy and had
less severe disease only 13% visited a dermatologist during the same period of
time.


The most frequent conditions that patients on therapy suffered from were: skin
infections - 33 infections were recorded; eczema, which was diagnosed 20 times;
and drug eruptions, which occurred mainly at the beginning of the treatment and
were important enough for 7 patients to stop therapy. In addition, 12 patients
were diagnosed with skin tumour and 9 with an ulcer. In total, 26% of the
patients who developed a dermatological condition ceased their treatment due to
the condition.


"Dermatological conditions are a significant and clinically important problem in
rheumatoid arthritis patients on TNF-alpha blocking therapy" conclude the
authors.


Dermatological conditions such as skin infections are common in rheumatoid
arthritis patients, but the use of TNF-alpha blocking therapy might increase
susceptibility, as TNF-alpha is a major player in the immune response to
infections. Down regulating TNF-alpha might also trigger another type of immune
response, which increases susceptibility to eczema, a condition not usually
associated with rheumatoid arthritis.















More prospective studies need to be carried out to investigate the incidence of
skin disease in patients on therapy, but this study reveals clinically
significant adverse effects of TNF-alpha blocking therapy.


This press release is based on the article:

Dermatological conditions during Tumor Necrosis Factor alpha blocking
therapy in patients with rheumatoid arthritis: a prospective study

M. Flendrie, W.H.P.M. Vissers, M.C.W. Creemers, E.M.G.J. de Jong,
P.C.M van de Kerkhof and P.L.C.M van Riel

Arthritis Research and Therapy 2005, 7:R666-R676 (4 April 2005)


This article is available free of charge, according to Arthritis Research and
Therapy's Open Access policy at

biomedcentral/content/qcpdf/ar1724.pdf



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View drug information on Vioxx.