Cutaneous adverse events associated with long-term immunomodulating therapy in multiple sclerosis
© Balak et al; licensee BioMed Central Ltd. 2011
Published: 23 November 2011
Multiple sclerosis (MS) is a common immune-mediated inflammatory disease of the central nervous system that causes severe neurological disability . Treatment is aimed at reducing disease progression via modulation of the immune system with disease-modifying therapies (DMTs) such as glatiramer acetate (GA) and interferon beta (IFN beta) . Skin reactions to DMT are common and involve localized inflammatory processes .
Our aim was to assess the prevalence and type of cutaneous adverse events associated with long-term use of DMT.
A cross-sectional study was conducted in 2010-2011 among 15 clinics in the Netherlands. Eligible for inclusion were MS patients who were treated with their first DMT for at least 2 years. All consecutive eligible patients willing to participate were enrolled, irrespective of the presence of skin reactions. Skin reactions were assessed from digital photographs of the injection-sites by dermatologists, who were blinded for the DMT.
A total of 146 patients were enrolled. The median age was 47 years (interquartile range [IQR] 41-54 years) and most patients (76%) were female. The median duration of DMT treatment was 4 years (IQR 3-8). Forty-four (30%) patients were treated with intramuscular (IM) IFN beta-1a, 43 (29%) with subcutaneous (SC) IFN beta-1a, 38 (26%) with IFN beta-1b, and 21 (14%) with GA. The proportion of patients with cutaneous adverse events was 40%, 77%, 63%, and 81% among patients receiving IM IFN beta-1a, SC IFN beta-1a, SC IFN beta-1b, and GA, respectively. Skin reactions were local injection-site reactions (61%), lipoatrophy (24%), healed skin ulcers (7%), postinflammatory hyperpigmentation (4%), urticaria (3%), and skin necrosis (1%).
The prevalence of cutaneous adverse events associated with DMT treatment was high. The most common skin reactions were local injection-site reactions and lipoatrophy related to panniculitis.
- Frohman EM, Racke MK, Raine CS: Multiple sclerosis--the plaque and its pathogenesis. N Engl J Med. 2006, 354 (9): 942-55. 10.1056/NEJMra052130.View ArticlePubMedGoogle Scholar
- Compston A, Coles A: Multiple sclerosis. Lancet. 2008, 372 (9648): 1502-17. 10.1016/S0140-6736(08)61620-7.View ArticlePubMedGoogle Scholar
- Buttmann M, Goebeler M, Toksoy A, Schmid S, Graf W, Berberich-Siebelt F, Rieckmann P: Subcutaneous interferon-beta injections in patients with multiple sclerosis initiate inflammatory skin reactions by local chemokine induction. J Neuroimmunol. 2005, 168 (1-2): 175-82. 10.1016/j.jneuroim.2005.07.011.View ArticlePubMedGoogle Scholar
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