title: [Adverse events during biological therapy -- focusing on dermatological side-effects].
abstract: Biological response modifiers, especially tumour necrosis factor inhibitors have been proved to be very effective in the treatment of various immune mediated rheumatological, gastroenterological and dermatological diseases in the last 15 years. With their increasing use, the incidence of their adverse effects are more precisely defined. The aim of this cohort study was to analyse the adverse effects occurred within the study period in patients receiving biological therapy for rheumatological and dermatological autoimmune diseases.
  
  
  METHODS
  324 patients within a 3 years study period were treated with biological response modifiers (adalimumab: 92, etanercept: 107, infliximab: 125). The primary diagnoses were rheumotoid arthritis (n = 174), ankylosing spondylitis (n = 60), psoriatic arthritis (n = 11), and psoriasis vulgaris (79).
  
  
  RESULTS
  Hypersensitive reactions were observed in 11 of the patients (3.4%), 7 of which were serious and needed treatment termination. Infections constituted the majority of side effects, which were localised to skin in 10 (3.1%) and to respiratory tract in 9 (2.8%). However, most of these were mild or moderate reactions. Malignant skin tumour developed in 1 case (0.3%) only. Drug induced inflammatory disorders occurred in some cases: onset of new psoriasis was observed in 1 and flares of the existing disease were detected in additional three. Lichenoid exanthema developed in one. (n = 5, 1.5%)
  
  
  CONCLUSIONS
  The use of TNF-α blockers may provoke a broad spectrum of dermatological side effects. Our results suggest that the majority of these are infectious and inflammatory disorders, the latter may relatively often appear as drug induced psoriasis. The occurrence of malignancies was very low in our series.
authors.affiliation: Miskolci Semmelweis Ignác Egészségügyi Központ Nonprofit Kft. Miskolc Csabai kapu 9-11. 3526. nagygabrielladr@freemail.hu
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nagy
authors.forename: Katalin
authors.initials: K
authors.lastname: Lukács
authors.forename: Agnes
authors.initials: A
authors.lastname: Sziray
authors.forename: Katalin
authors.initials: K
authors.lastname: Fazekas
authors.forename: Agnes
authors.initials: A
authors.lastname: Florián
authors.forename: László
authors.initials: L
authors.lastname: Tamási
authors.forename: Zsuzsánna
authors.initials: Z
authors.lastname: Károlyi
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D015331:Cohort Studies; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000209:etiology*; D004342:Drug Hypersensitivity / Q000209:etiology; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D012871:Skin Diseases / Q000139:chemically induced / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D012878:Skin Neoplasms / Q000139:chemically induced; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept