Correspondence

Dasatinib-induced lupus

Drug-induced lupus erythematosus (DILE) refers to a condition whose clinical, histological, and immunological features are similar to those seen in idiopathic lupus erythematosus but that occurs when certain drugs are taken and resolves after their withdrawal. Over 90 drugs have been linked to DILE to date and the list is growing. Like idiopathic lupus erythematosus, DILE has systemic, subacute cutaneous, and chronic cutaneous forms. A correct diagnosis is very important, as this condition usually resolves after withdrawal of the offending drug.

El término lupus eritematoso inducido por fármacos (LEIF) hace referencia a una entidad caracterizada por la aparición de manifestaciones clínicas, histopatológicas e inmunológicas similares a aquellas que aparecen en el lupus eritematoso idiopático, pero que cronológicamente coinciden con la toma de ciertos fármacos y que se resuelven tras la retirada de los mismos. Más de 90 fármacos se han asociado con la aparición de LEIF. Esta lista de fármacos implicados sigue aumentando. Al igual que el lupus eritematoso idiopático, el LEIF se puede subclasificar en lupus eritematoso sistémico inducido por fármacos, lupus eritematoso cutáneo subagudo inducido por fármacos y lupus eritematoso cutáneo crónico inducido por fármacos. Reconocer estas entidades es de gran interés, ya que este cuadro suele revertir tras la retirada del fármaco implicado.

Autoimmunity can follow exposure to drugs or other agents. There are increasing numbers of reports and case series of patients who develop autoantibodies and lupus-like syndromes following exposure to certain medications and environmental agents, resulting in the development of drug-related lupus (DRL). The most frequently reported clinical features include constitutional symptoms, arthralgias/arthritis, serositis, and the development of autoantibodies. Systemic lupus erythematosus (SLE) is an autoimmune disease for which the etiology remains undetermined despite intensive research. There is evidence to suggest that genetic factors play a major role in the pathogenesis of this disease. The term “drug-related lupus” refers to the development of a lupus-like syndrome following exposure to a certain drug. An important feature of DRL is a temporal association between the ingestion of an agent and development of lupus-like features with remission of the features and decrease in autoantibody titers following withdrawal of the offending agent. Typical features of DRL include constitutional symptoms, arthralgias/arthritis, myalgias, serositis, elevated ESR, and a positive ANA, which is generally accepted as a requirement for the diagnosis. Specific clinical features for the diagnosis of DRL have not as yet been defined. There are as yet no established criteria for the diagnosis of DR and the definitive treatment is withdrawal of the offending agent. Physicians need to be aware of possible associations between the development of autoimmune-like features and exposure to certain pharmacologic agents for both diagnostic and therapeutic reasons.

Le nilotinib (Tasigna^®) est un inhibiteur de tyrosine-kinase de deuxième génération (ITK2) d'introduction récente, indiqué dans le traitement des patients atteints de leucémie myéloïde chronique (LMC) en phase chronique (PC) ou accélérée (PAcc), intolérants ou résistants à l'imatinib. Ce traitement a permis une avancée importante dans la maîtrise de la maladie chez de tels patients, mais peut être source d'effets indésirables gênants, parfois sévères, qui peuvent limiter son utilisation optimale. Nous proposons dans ce travail des recommandations pratiques qui sont susceptibles d'aider le prescripteur dans la gestion de ces effets indésirables.

Nilotinib (Tasigna^®) is a second-generation BCR-ABL kinase inhibitor, recently introduced and used for the treatment of chronic or accelerated phase CML patients, intolerant or resistant to imatinib. This treatment represents and important step forward for the disease control of such patients but can lead to side effects, sometimes serious, which can limit its optimal use. We propose here some guidelines that might be of help in daily practice, in order to manage properly these side effects.

Autoimmunity can follow exposure to drugs or other agents. There are increasing numbers of reports and case series of patients who develop autoantibodies and lupus-like syndromes following exposure to certain medications and environmental agents, resulting in the development of drug-related lupus (DRL). The most frequently reported clinical features include constitutional symptoms, arthralgias/arthritis, serositis, and the development of autoantibodies. Systemic lupus erythematosus (SLE) is an autoimmune disease for which the etiology remains undetermined despite intensive research. There is evidence to suggest that genetic factors play a major role in the pathogenesis of this disease. The term “drug-related lupus” refers to the development of a lupus-like syndrome following exposure to a certain drug. An important feature of DRL is a temporal association between the ingestion of an agent and development of lupus-like features with remission of the features and decrease in autoantibody titers following withdrawal of the offending agent. Typical features of DRL include constitutional symptoms, arthralgias/arthritis, myalgias, serositis, elevated ESR, and a positive ANA, which is generally accepted as a requirement for the diagnosis. Specific clinical features for the diagnosis of DRL have not as yet been defined. There are as yet no established criteria for the diagnosis of DR and the definitive treatment is withdrawal of the offending agent. Physicians need to be aware of possible associations between the development of autoimmune-like features and exposure to certain pharmacologic agents for both diagnostic and therapeutic reasons.