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Off-Label Dermatologic Uses of Anti-TNF-a Therapies

  • Published:
Journal of Cutaneous Medicine and Surgery

Abstract

Background

Tumor necrosis factor-alpha (TNF-a) is a proinflammatory cytokine that plays an immunomodulatory role in a variety of systemic and dermatologic diseases. Currently, three anti-TNF-a drugs are available in North America— infliximab (approved in the U.S. for the treatment of rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, ulcerative colitis, and psoriatic arthritis), etanercept (approved in the U.S. for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis), and adalimumab (approved for the treatment of rheumatoid arthritis and psoriatic arthritis).

Objective

To review the current literature supporting alternative (and currently off-label) dermatologic uses of TNF-a antagonists.

Methods

A MEDLINE search (1966–March 2005) was conducted using the keywords “infliximab,” “etanercept,” “adalimumab,” “TNF inhibitors,” and “off-label” to identify published reports of off-label dermatologic uses of TNF-a inhibitors.

Results

Anti-TNF-a therapies have been reported in the following dermatologic diseases: sarcoidosis, hidradenitis suppuritiva, cicatricial pemphigoid, Behçet’s disease, pyoderma gangrenosum, multicentric reticulohistiocytosis, apthous stomatitis, Sneddon–Wilkinson disease, SAPHO syndrome, pityriasis rubra pilaris, eosinophilic fasciitis, panniculitis, Crohn’s disease, necrobiosis lipoidica diabeticorum, dermatomyositis, and scleroderma. The vast majority of these reports are in the form of individual case reports and small case series. Only two published randomized controlled trials involving the off-label use of a TNF inhibitor were found.

Conclusions

A growing number of published reports suggest that anti-TNF-a therapies may be effective in the treatment of numerous inflammatory skin diseases outside their currently approved indications.

Sommaire

Antécédents

Le facteur de nécrose des tumeurs alpha (TNF-a) est une cytokine proinflammatoire qui joue un rôle immunomodulateur dans diverses affections cutanées et systémiques. Actuellement, trois médicaments sont prescrits contre le TNF-a en Amérique du Nord : infliximab (approuvé aux É.-U. pour le traitement de la polyarthrite rhumatoïde, la maladie de Crohn, la spondylarthrite ankylosante et la polyarthrite psoriasique), étanercept (approuvé aux É.-U. pour le traitement de la polyarthrite rhumatoïde, l’arthrite chronique juvénile, la polyarthrite psoriasique, la spondylarthrite ankylosante et le psoriasis), et adalimumab (approuvé pour le traitement de la polyarthrite rhumatoïde).

Objectif

Passer en revue les publications actuelles en faveur de l’usage dermatologique alternatif (et en dehors des indications actuelles) des antagonistes de TNF-a.

Méthodes

Une recherche dans la base de données MEDLINE (de 1966 à mars 2005) a été faite au moyen des termes clés «infliximab», «étanercept», «adalimumab», «TNF inhibitors» et «off-label» afin d’identifier les rapports publiés sur l’utilisation des inhibiteurs de TNF-a en dehors des indications figurant sur l’information professionnelle.

Résultats

Selon les rapports obtenus, les traitements contre le TNF-a ont été utilisés dans des cas présentant les maladies cutanées suivantes : sarcoïdose, hidrosadénite, pemphigoïde cicatricielle, maladie de Behcet, pyoderma gangrenosum, réticulocytose, stomatite aphteuse, maladie de Sneddon-Wilkinson, syndrome de SAPHO, pityriasis rubra pilaire, fasciite à éosinophiles, panniculite, maladie de Crohn, nécrobiose lipoïdique, dermatomyosite et sclérodermie. La majorité de ces rapports se présentent sous forme de rapports de cas individuels et de séries de courts rapports. Seules deux études sur des échantillons contrôlés et aléatoires ont été trouvées sur l’usage en dehors des indication de l’inhibiteur de TNF.

Conclusions

Un nombre croissant de rapports publiés montrent que les traitements contre le TNF-a seraient efficaces pour le traitement de plusieurs affections cutanées non indiquées.

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Authors and Affiliations

  1. Department of Dermatology, St. Luke’s-Roosevelt Hospital Center, New York, NY, USA

    Andrew F. Alexis

  2. The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA

    Bruce E. Strober

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  1. Andrew F. Alexis
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  2. Bruce E. Strober
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Correspondence to Bruce E. Strober.

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Alexis, A.F., Strober, B.E. Off-Label Dermatologic Uses of Anti-TNF-a Therapies. J Cutan Med Surg 9, 296–302 (2005). https://doi.org/10.1007/s10227-005-0110-7

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  • DOI: https://doi.org/10.1007/s10227-005-0110-7

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