Karolina Vorcakova

By Karolína Vorčáková, Péč Juraj, Péčová Tatiana and Martinásková Klára

Biologic agents that act by inhibiting tumour necrosis factor alpha (TNF-alpha) have become a breakthrough treatment for chronic inflammatory diseases. This highly effective treatment has surprisingly brought us new adverse effects that we had not encountered before the age of biologics. Immune-mediated reactions are a group of adverse effects with not clearly understood etiopathogenesis. It turns out that TNF-alpha inhibitors are able to disrupt the cytokine cascade in genetically predisposed individuals. Some of the theories assume a cross reaction and overproduction of interferon (INF) alpha, while others put an emphasis on dysregulation of cytokines, in particular interleukin (IL)-17. Similarly, debatable is the role of the reactions mentioned in the etiopathogenesis, the production of antibodies against biologics and the production of antinuclear antibodies. The most common immune-mediated skin reactions are psoriasis and psoriasiform reactions, lupus-like syndrome, sarcoidosis, alopecia areata, vasculitis and lichenoid reactions. Less common reactions described in our paper include pyoderma gangrenosum and morphea. Most of these reactions belong to the so-called paradoxical reactions. Paradoxical psoriasis is an adverse effect, represented by occurrence of a disease caused by the therapeutic class of drugs normally used to cure or improve symptoms of such disease.

Part of the book: Antibody Engineering

By Karolina Vorčáková, Tatiana Péčová, Klára Martinásková, Katarína Nováčeková and Juraj Péč

Tumor necrosis factor alpha (TNF alpha) inhibitors are widely and effectively used for inflammatory and autoimmune diseases in rheumatology, gastroenterology, and dermatology. Adalimumab, etanercept, and infliximab are indicated for the treatment of patients with moderate to severe chronic plaque psoriasis. This target treatment is very effective and lead to control the most severe cases, which were formerly fatal. Biologic treatment is strictly monitored. These large molecules, even with the same mechanism of action in the form of inhibiting TNF alpha, may act differently, and they may have other adverse effects. Skin complications of anti-TNF alpha treatment include a wide range of manifestations which can be divided into four groups: infections, reactions directly associated with drug administration, immune-mediated skin reaction, and malignancy. This chapter describes currently available information regarding the occurrence of individual complications and defines possible therapeutic options in case of individual adverse reactions.

Part of the book: Tailored Treatments in Psoriatic Patients