Reactions 1486, p6 - 1 Feb 2014

SAdalimumab/etanercept/rituximab

Leucopenia and subacute cutaneous lupuserythematosus: case report

A 31-year-old woman developed leucopenia while receivingadalimumab and etanercept, and subacute cutaneous lupuserythematosus when her therapy was changed to rituximab.

The woman had a 7-year history of rheumatoid arthritis(RA), and was started on aggressive treatment with etanercept50mg weekly [route not stated].

The woman’s etanercept was stopped after 18 months dueto the development of leucopenia. Her leucopenia resolvedwith corticosteroid use. However, the RA activity increased,and she was commenced on adalimumab 40mg every 2 weeks[route not stated]. Leucopenia occurred after the second doseof adalimumab, and the drug was withdrawn. Three monthsafter stopping adalimumab, an increase in RA activity wasagain observed, and she received two IV rituximab 1000mginfusions at an interval of 2 weeks. Rituximab was stopped dueto erythematous lesions appearing on her face anddecolletage, and she was referred to a dermatology clinic. Aphysical examination showed erythematous lesions of annularor oval shape evident on her lips, cheeks, ears and decolletage.She also exhibited tender and swollen symmetrical joints.Laboratory tests revealed leucopenia, lymphopenia andmonocytosis, and she was positive for Ro/SS-A and La/SS-B.Histopathological analysis of a skin lesion was characteristicfor subacute cutaneous lupus erythematosus. She was givencorticosteroid treatment, and the lesions resolved within1 month. However, 6 months later, granular deposits of IgM,IgG and C3 were still evident at the dermo-epidermal junction.

Author comment: "The reduction in leukocyte numberwas reported after 18 month [of] therapy with etanercept.The treatment with [another] inhibitor of TNF-α –adalimumab caused the recurrence of leucopenia." "Thecomplete clinical manifestation of [subacute cutaneous lupuserythematosus] developed after starting the rituximabtherapy, and thus the presented case seems to provideevidence that this manifestation derived from this treatment."Lis-Swiety A, et al. Subacute cutaneous lupus erythematosus in the course ofrheumatoid arthritis: a relationship with TNF-alpha antagonists and rituximabtherapy?. Immunopharmacology and Immunotoxicology 35: 443-6, No. 3, Jun2013 - Poland 803098744

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Reactions 1 Feb 2014 No. 14860114-9954/14/1486-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved