PMID- 33837059
OWN - NLM
STAT- MEDLINE
DCOM- 20211215
LR  - 20211215
IS  - 2332-7812 (Electronic)
IS  - 2332-7812 (Linking)
VI  - 8
IP  - 3
DP  - 2021 May
TI  - Skin Reactions in Patients With Multiple Sclerosis Receiving Cladribine 
      Treatment.
LID - 10.1212/NXI.0000000000000990 [doi]
LID - e990
AB  - OBJECTIVE: To report 77 patients with multiple sclerosis (MS) who developed 
      skin-related adverse events (AEs) following treatment with cladribine. METHODS: 
      We evaluated our prospective bicentric cladribine cohort. Cladribine-treated 
      patients with a skin AE were identified. RESULTS: Two hundred thirty-nine 
      cladribine-treated patients with MS were evaluated. Seventy-seven patients (32%) 
      showed at least 1 skin AE at median 1 month after cladribine initiation (range: 
      1-12). Within first 3 months following last cladribine exposition, hair thinning 
      (n = 28, 12%), skin rash (n = 20; 8%), mucositis (n = 13, 5%), and pruritus (n = 
      6, 3%) were observed. Furthermore, 35 patients (15%) developed herpes virus 
      infections (time since last cladribine exposition: median 83 [range: 10-305]). In 
      15 patients, herpes zoster infection was severe (CTCAE grade >/= 3) and required 
      hospitalization. Delayed skin AEs (>/=3 months after a cladribine treatment cycle) 
      involved 1 case of leukocytoclastic vasculitis and 2 cases of alopecia areata. 
      Finally, 2 patients presented with in total 3 isolated precancerous lesions (1 
      leukoplakia simplex and 2 actinic keratosis) and 1 patient developed a squamous 
      cell carcinoma. CONCLUSION: Skin AEs are common in patients with MS treated with 
      cladribine. Until risk management plans have been adjusted to include these 
      phenomena, clinicians should perform a thorough clinical follow-up and in 
      suspicious cases seek early interdisciplinary support. In light of the observed 
      delayed skin reactions, we further emphasize the necessity of careful clinical 
      surveillance of cladribine-treated patients for yet undescribed secondary 
      autoimmune events. CLASSIFICATION OF EVIDENCE: This study provides Class IV 
      evidence that skin-related AEs are frequent in patients with MS following 
      cladribine in a real-world setting.
CI  - Copyright (c) 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on 
      behalf of the American Academy of Neurology.
FAU - Rolfes, Leoni
AU  - Rolfes L
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany. leoni.rolfes@ukmuenster.de.
FAU - Pfeuffer, Steffen
AU  - Pfeuffer S
AUID- ORCID: 0000-0001-5171-4845
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Hackert, Jana
AU  - Hackert J
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Pawlitzki, Marc
AU  - Pawlitzki M
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Ruck, Tobias
AU  - Ruck T
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Sondermann, Wiebke
AU  - Sondermann W
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Korsen, Melanie
AU  - Korsen M
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Wiendl, Heinz
AU  - Wiendl H
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Meuth, Sven G
AU  - Meuth SG
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Kleinschnitz, Christoph
AU  - Kleinschnitz C
AUID- ORCID: 0000-0002-1650-8875
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
FAU - Pul, Refik
AU  - Pul R
AD  - From the Department of Neurology (L.R., S.P., M.P., T.R., H.W.), Institute of 
      Translational Neurology, University Hospital of Munster, Germany; Department of 
      Neurology (J.H., C.K., R.P.), University Hospital Essen, University 
      Duisburg-Essen, Essen, Germany; Department of Dermatology (W.S.), University 
      Hospital Essen, University Duisburg-Essen, Essen, Germany; and Department of 
      Neurology (M.K., S.G.M.), University Hospital Dusseldorf, 
      Heinrich-Heine-University Dusseldorf, Germany.
LA  - eng
PT  - Journal Article
DEP - 20210409
PL  - United States
TA  - Neurol Neuroimmunol Neuroinflamm
JT  - Neurology(R) neuroimmunology & neuroinflammation
JID - 101636388
RN  - 47M74X9YT5 (Cladribine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cladribine/*adverse effects
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis/*complications/*drug therapy
MH  - Prospective Studies
MH  - Skin
MH  - Skin Diseases/*chemically induced
PMC - PMC8042777
EDAT- 2021/04/11 06:00
MHDA- 2021/12/16 06:00
PMCR- 2021/04/09
CRDT- 2021/04/10 05:38
PHST- 2020/12/07 00:00 [received]
PHST- 2021/02/16 00:00 [accepted]
PHST- 2021/04/10 05:38 [entrez]
PHST- 2021/04/11 06:00 [pubmed]
PHST- 2021/12/16 06:00 [medline]
PHST- 2021/04/09 00:00 [pmc-release]
AID - 8/3/e990 [pii]
AID - NEURIMMINFL2020038323 [pii]
AID - 10.1212/NXI.0000000000000990 [doi]
PST - epublish
SO  - Neurol Neuroimmunol Neuroinflamm. 2021 Apr 9;8(3):e990. doi: 
      10.1212/NXI.0000000000000990. Print 2021 May.