mercaptopurine and Psoriasis

Topics: Administration, Topical; Anthralin; Azathioprine; Azauridine; Chemical Phenomena; Chemistry; Humans; Hydroxyurea; Mercaptopurine; Mustard Compounds; Mycophenolic Acid; Psoriasis

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Aspirin; Chlorambucil; Cyclophosphamide; Granulomatosis with Polyangiitis; Hepatitis; Humans; Immunosuppressive Agents; Liver Cirrhosis; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Mice; Mice, Inbred NZB; Multiple Sclerosis; Nephritis; Nephrosis; Nitrogen Mustard Compounds; Penicillins; Psoriasis; Uveitis, Anterior

Topics: Animals; Anti-Inflammatory Agents; Antineoplastic Agents; Arthritis, Rheumatoid; Azathioprine; Chlorambucil; Colitis, Ulcerative; Crohn Disease; Cyclophosphamide; Granulomatosis with Polyangiitis; Hepatitis; Humans; Immune Complex Diseases; Immunosuppressive Agents; Infections; Liver Cirrhosis, Biliary; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Nephrotic Syndrome; Ophthalmia, Sympathetic; Psoriasis; Thioguanine; Uveitis

Therapy-related myeloid neoplasms are a potentially life-threatening consequence of treatment for autoimmune disease (AID) and an emerging clinical phenomenon.. To query the association of cytotoxic, anti-inflammatory, and immunomodulating agents to treat patients with AID with the risk for developing myeloid neoplasm.. This retrospective case-control study and medical record review included 40 011 patients with an International Classification of Diseases, Ninth Revision, coded diagnosis of primary AID who were seen at 2 centers from January 1, 2004, to December 31, 2014; of these, 311 patients had a concomitant coded diagnosis of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Eighty-six cases met strict inclusion criteria. A case-control match was performed at a 2:1 ratio.. Odds ratio (OR) assessment for AID-directed therapies.. Among the 86 patients who met inclusion criteria (49 men [57%]; 37 women [43%]; mean [SD] age, 72.3 [15.6] years), 55 (64.0%) had MDS, 21 (24.4%) had de novo AML, and 10 (11.6%) had AML and a history of MDS. Rheumatoid arthritis (23 [26.7%]), psoriasis (18 [20.9%]), and systemic lupus erythematosus (12 [14.0%]) were the most common autoimmune profiles. Median time from onset of AID to diagnosis of myeloid neoplasm was 8 (interquartile range, 4-15) years. A total of 57 of 86 cases (66.3%) received a cytotoxic or an immunomodulating agent. In the comparison group of 172 controls (98 men [57.0%]; 74 women [43.0%]; mean [SD] age, 72.7 [13.8] years), 105 (61.0%) received either agent (P = .50). Azathioprine sodium use was observed more frequently in cases (odds ratio [OR], 7.05; 95% CI, 2.35- 21.13; P < .001). Notable but insignificant case cohort use among cytotoxic agents was found for exposure to cyclophosphamide (OR, 3.58; 95% CI, 0.91-14.11) followed by mitoxantrone hydrochloride (OR, 2.73; 95% CI, 0.23-33.0). Methotrexate sodium (OR, 0.60; 95% CI, 0.29-1.22), mercaptopurine (OR, 0.62; 95% CI, 0.15-2.53), and mycophenolate mofetil hydrochloride (OR, 0.66; 95% CI, 0.21-2.03) had favorable ORs that were not statistically significant. No significant association between a specific length of time of exposure to an agent and the drug's category was observed.. In a large population with primary AID, azathioprine exposure was associated with a 7-fold risk for myeloid neoplasm. The control and case cohorts had similar systemic exposures by agent category. No association was found for anti-tumor necrosis factor agents. Finally, no timeline was found for the association of drug exposure with the incidence in development of myeloid neoplasm.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Autoimmune Diseases; Azathioprine; Case-Control Studies; Cyclophosphamide; Female; Humans; Immunosuppressive Agents; Incidence; Leukemia, Myeloid, Acute; Lupus Erythematosus, Systemic; Male; Mercaptopurine; Methotrexate; Middle Aged; Mitoxantrone; Mycophenolic Acid; Myelodysplastic Syndromes; Odds Ratio; Psoriasis; Retrospective Studies; Risk Factors; United States

Anti-tumor necrosis factor (anti-TNF) agents are widely used to treat patients with moderate-to-severe inflammatory bowel disease (IBD). We aimed to identify the risk factors for adverse skin lesions in patients with IBD receiving anti-TNF agents and assess the effect of concomitant use of azathioprine/6-mercaptopurine (AZA/6 MP).. A total of 500 patients (404 with Crohn's disease, 96 with ulcerative colitis) who received anti-TNF agents between June 2002 and July 2013 were identified and retrospectively investigated. We compared 47 patients with IBD with skin lesions with 443 patients with IBD without skin lesions to identify risk factors by univariate and multivariate analysis. The Kaplan-Meier method was used to estimate the cumulative incidence of adverse skin lesions in relation to the concomitant use of AZA/6 MP.. Eczematiform eruptions (n = 18, 38%) were the most common skin lesion type, followed by psoriasiform lesions (n = 13, 28%). A response to topical steroids was seen in 70% (33/47) of patients with skin lesions, and anti-TNF agents had to be discontinued in 9% (4/47). Concomitant use of AZA/6 MP decreased the risk of skin lesions in univariate (hazard ratio, 0.452; 95% CI, 0.251-0.814; P = 0.008) and multivariate (hazard ratio, 0.437; 95% CI, 0.242-0.790; P = 0.006) analysis. In addition, the cumulative incidence of adverse skin lesions was lower in patients on concomitant maintenance with AZA/6 MP (P = 0.009) than in those on anti-TNF monotherapy.. Concomitant use of AZA/6 MP may decrease the occurrence of adverse skin lesions in patients receiving anti-TNF therapy.

Topics: Adolescent; Adult; Aged; Azathioprine; Body Mass Index; Colitis, Ulcerative; Crohn Disease; Drug Eruptions; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Mercaptopurine; Middle Aged; Psoriasis; Retrospective Studies; Risk Factors; Smoking; Th1 Cells; Th17 Cells; Tumor Necrosis Factor-alpha; Young Adult

The risk of non-Hodgkin's lymphoma (NHL) with tumor necrosis factor alpha (TNF-α) inhibitors is unclear, whether related to concomitant thiopurines usage or due to the underlying inflammatory disease. We sought to review all cases of T-cell NHL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors for all approved indications and examine the risk of T-cell NHL with TNF-α inhibitors in comparison with the use of thiopurines in inflammatory bowel disease (IBD).. The FDA Adverse Event Reporting System (AERS) was queried for all lymphomas following treatment with the following TNF-α inhibitors: infliximab, adalimumab, certolizumab, etanercept, and their trade names. Full reports for T-cell NHL cases were identified using the Freedom of Information Act. In addition, T-cell NHL reported in patients IBD with the use of the thiopurines-azathioprine, 6-mercaptopurine, and their trade names were also collected. A search of MEDLINE was performed for additional T-cell NHL with TNF-α inhibitors or thiopurines, not reported to the FDA but available in published literature. The histological subtypes of T-cell NHL reported with TNF-α inhibitors were compared with reported subtypes in Surveillance Epidemiology and End Results (SEER) -17 registry. Reported risk of T-cell NHL in IBD with TNF-α inhibitors, thiopurines, or concomitant use was calculated using Fisher's exact test using 5-aminosalicylates as control drugs.. A total of 3,130,267 reports were downloaded from the FDA AERS (2003-2010). Ninety-one cases of T-cell NHL with TNF-α inhibitors were identified in the FDA AERS and nine additional cases were identified on MEDLINE search. A total of 38 patients had rheumatoid arthritis, 36 cases had Crohn's disease, 11 had psoriasis, 9 had ulcerative colitis, and 6 had ankylosing spondylitis. Sixty-eight of the cases (68%) involved exposure to both a TNF-α inhibitor and an immunomodulator (azathioprine, 6-mercaptopurine, methotrexate, leflunomide, or cyclosporine). Hepatosplenic T-cell lymphoma (HSTCL) was the most common reported subtype, whereas mycosis fungoides/Sezary syndrome and HSTCL were identified as more common with TNF-α-inhibitor exposure compared with SEER-17 registry. Nineteen cases of T-cell NHL with thiopurines were identified in the FDA AERS and one additional case on MEDLINE. Reported risk of T-cell NHL was higher with TNF-α inhibitor use in combination with thiopurines (95% confidence interval (CI) 4.98-354.09; P<0.0001) and thiopurines alone (95% CI 8.32-945.38; P<0.0001) but not with TNF-α inhibitor use alone (95% CI 0.13-10.61; P=1.00).. Risk of T-cell NHL is increased with TNF-α inhibitor use in combination with thiopurines but not with TNF-α inhibitors alone.

Topics: Adalimumab; Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Arthritis, Rheumatoid; Azathioprine; Certolizumab Pegol; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin Fab Fragments; Immunoglobulin G; Immunosuppressive Agents; Inflammatory Bowel Diseases; Infliximab; Lymphoma, T-Cell; Male; MEDLINE; Mercaptopurine; Middle Aged; Odds Ratio; Polyethylene Glycols; Psoriasis; Receptors, Tumor Necrosis Factor; Risk Factors; SEER Program; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha; United States; United States Food and Drug Administration

In a patient with psoriatic erythroderma treated with Methotrexate and later with Buthiopurine, porphyrinuria and later porphyria cutanea tarda developed, following a toxic reaction with bone marrow suppression. Hepatological examination before therapy did not reveal any signs of active liver disease.

Topics: Aged; Antineoplastic Agents; Drug Therapy, Combination; Humans; Liver; Male; Mercaptopurine; Methotrexate; Porphyrias; Psoriasis

Topics: Arthritis; Humans; Mercaptopurine; Psoriasis

Topics: Adult; Aged; Arthritis, Rheumatoid; Azathioprine; Blood Sedimentation; Female; Follow-Up Studies; Humans; Male; Mercaptopurine; Middle Aged; Psoriasis; Scleroderma, Localized

Topics: Adolescent; Adult; Antimetabolites, Antineoplastic; Chlorambucil; Cyclophosphamide; Drug Evaluation; Fluorouracil; Humans; Mercaptopurine; Middle Aged; Nitrogen Mustard Compounds; Psoriasis

Topics: Adult; Aged; Azathioprine; Female; Humans; Male; Mercaptopurine; Methotrexate; Middle Aged; Psoriasis

Topics: Adrenal Cortex Hormones; Adult; Antimetabolites; Chronic Disease; Drug Combinations; Humans; Male; Mercaptopurine; Methotrexate; Middle Aged; Psoriasis; Recurrence; Remission, Spontaneous

Topics: Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Male; Mercaptopurine; Psoriasis; Pyrogens; Thiamine; Vitamin B 12

Topics: Adolescent; Adult; Child; Deoxyribonucleases; Female; Humans; Interferons; Leukocytes; Male; Mercaptopurine; Methotrexate; Psoriasis

Topics: Adrenocorticotropic Hormone; Adult; Antimetabolites; Coal Tar; Dermatitis, Exfoliative; Glucocorticoids; Humans; Hydrocortisone; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Oral Manifestations; Prednisolone; Psoriasis; Sepsis; Skin Diseases; Ulcer

Topics: Adrenal Cortex Hormones; Anemia, Hemolytic, Autoimmune; Animals; Autoimmune Diseases; Azathioprine; Corneal Transplantation; Dactinomycin; Humans; Immunosuppressive Agents; Kidney Diseases; Mercaptopurine; Plasmacytoma; Psoriasis; Transplantation Immunology

Topics: Antineoplastic Agents; Azathioprine; Condylomata Acuminata; Fluorouracil; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Papilloma; Pemphigus; Precancerous Conditions; Psoriasis; Scleroderma, Systemic; Skin Diseases; Skin Neoplasms; Virus Diseases

Topics: Adolescent; Adult; Aged; Ambulatory Care; Female; Humans; Male; Mercaptopurine; Middle Aged; Psoriasis

Topics: Arthritis; Cyclophosphamide; Humans; Male; Mercaptopurine; Middle Aged; Nitrogen Mustard Compounds; Psoriasis

Topics: Drug Therapy; Humans; Mercaptopurine; Psoriasis

Topics: Allergens; Allergy and Immunology; Aniline Compounds; Antibody Formation; Antigen-Antibody Reactions; Antineoplastic Agents; Azathioprine; Benzene; Catechols; Geriatrics; Humans; Hypersensitivity, Delayed; Immunocompetence; Immunosuppressive Agents; Mercaptopurine; Methotrexate; Pharmacology; Plague Vaccine; Psoriasis; Thioguanine; Triethylenemelamine; Vinblastine

Topics: Antimetabolites; Epidermis; Fluorouracil; Hair; Humans; Mercaptopurine; Methotrexate; Psoriasis; Skin

Topics: Antimetabolites; Gout; Humans; Leukemia; Mercaptopurine; Pharmacology; Psoriasis; Purines; Pyrazoles; Pyrimidines

Topics: Humans; Mercaptopurine; Psoriasis