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Utilização Off-Label de Terapêutica Biológica em Dermatologia. Experiência Clínica de 5 Anos
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Abstract(s)
Introdução: Nos últimos anos, a terapêutica biológica expandiu de forma expressiva as opções terapêuticas disponíveis em Dermatologia. Ainda que o seu uso esteja apenas aprovado no tratamento da psoríase e
psoríase atropática, a utilização off-label em diversas dermatoses inflamatórias tem sido descrita de forma crescente na literatura. Métodos: Efectuou-se um estudo retrospectivo dos doentes com dermatoses (que não a psoríase) tratados com terapêutica biológica entre Janeiro de 2005 e Dezembro de 2009, no nosso Serviço. Foram analisados os dados clínicos, as terapêuticas efectuadas, a eficácia e o perfil de segurança. Resultados: Foram incluídos 15 doentes e tratadas 7 diferentes patologias dermatológicas resistentes às terapêuticas convencionais. O etanercept foi utilizado em 4 casos: 3 doentes com Esclerodermia sistémica (2 doentes interromperam a terapêutica antes das 12 semanas por efeitos adversos graves; no 3º doente verificaram-se bons resultados) e um doente com granuloma elastolítico, no qual se registou uma boa resposta clínica. O infliximab foi utilizado com sucesso em 4 doentes (3 casos de doença de Behçet e 1 de pitiríase rubra pilar). O adalimumab foi utilizado num caso de dermatose pustulosa subcórnea com excelentes resultados. O efalizumab foi ineficaz em 2 casos de dermite atópica. O rituximab foi utilizado em 5 doentes: 3 casos de pênfigo (com excelentes resultados terapêuticos) e 2 casos de dermite atópica (numa doente houve uma boa resposta, mas interrompeu a terapêutica após 1 semana de tratamento por gravidez e na 2ª doente não se observou qualquer melhoria significativa). Conclusão: A terapêutica biológica tem demonstrado eficácia no tratamento de várias dermatoses; no entanto a maioria da informação disponível na literatura é referente a casos isolados ou a pequenas séries de casos. Apesar da nossa experiência ser limitada, estes resultados parecem-nos promissores na terapêutica de determinadas dermatoses inflamatórias refractárias aos tratamentos convencionais.
Introduction: In recent years, the development of numerous biologic agents extended the therapeutic armamentarium available to dermatologists. Although they are currently approved only for psoriasis, experience is being accumulated with its use in the treatment of different inflammatory skin diseases. Methods: This was a retrospective study of all patients treated in our department with biologic agents for skin disease other than psoriasis. We analyzed the clinical data, previous and concomitant treatments, efficacy and safety profile of these agents in this setting. Results: 15 patients were included with 7 different skin diseases resistant to conventional therapies. Etanercept was used in 4 cases: 3 patients with scleroderma (2 patients developed major side effects and had to interrupt treatment, while the third patient had a good response) and one patient with elastolytic granuloma. Four patients were treated successfully with infliximab (3 cases of Behçet’s disease and 1 case of pytiriasis rubra pilaris). Adalimumab was used to treat a patient with subcorneal pustular dermatosis with excellent results. Efalizumab was ineffective in 2 cases of atopic dermatitis. Rituximab was used in 5 patients: 3 cases of pemphigus (with complete clinical improvement) and 2 patients with atopic dermatitis (1 patient had a good response but had to interrupt treatment because she become pregnant and in the other patient there wasn’t any clinical improvement). Conclusion: Biologic immunomodulators have demonstrated efficacy in the treatment of several dermatologic diseases; however, most of the available information are individual case reports or small case series. Despite our limited experience in this setting, these results seem promising in the treatment of some inflammatory skin diseases resistant to conventional therapies.
Introduction: In recent years, the development of numerous biologic agents extended the therapeutic armamentarium available to dermatologists. Although they are currently approved only for psoriasis, experience is being accumulated with its use in the treatment of different inflammatory skin diseases. Methods: This was a retrospective study of all patients treated in our department with biologic agents for skin disease other than psoriasis. We analyzed the clinical data, previous and concomitant treatments, efficacy and safety profile of these agents in this setting. Results: 15 patients were included with 7 different skin diseases resistant to conventional therapies. Etanercept was used in 4 cases: 3 patients with scleroderma (2 patients developed major side effects and had to interrupt treatment, while the third patient had a good response) and one patient with elastolytic granuloma. Four patients were treated successfully with infliximab (3 cases of Behçet’s disease and 1 case of pytiriasis rubra pilaris). Adalimumab was used to treat a patient with subcorneal pustular dermatosis with excellent results. Efalizumab was ineffective in 2 cases of atopic dermatitis. Rituximab was used in 5 patients: 3 cases of pemphigus (with complete clinical improvement) and 2 patients with atopic dermatitis (1 patient had a good response but had to interrupt treatment because she become pregnant and in the other patient there wasn’t any clinical improvement). Conclusion: Biologic immunomodulators have demonstrated efficacy in the treatment of several dermatologic diseases; however, most of the available information are individual case reports or small case series. Despite our limited experience in this setting, these results seem promising in the treatment of some inflammatory skin diseases resistant to conventional therapies.
Description
Keywords
HSAC DER Uso Off-Label Dermatite Atópica Esclerodermia Sistémica Doença de Behçet Pênfigo Granuloma Pitiríase Rubra Pilar Dermatose Pustulosa Subcorneal
Citation
Trab Soc Port Dermatol Venereol 2011;69(1):49-67