Page 24 - SPD Review Winter 2014

Literature Review - Winter 2014

 DRUGS AND THERAPY
midis and Pseudomonas aeruginosa, presenting with bullae and pustules. The

authors conclude that, in general, the beneits of biologics outweigh the risk but

Vinay K, Kanwar AJ, Sawatkar GU, Dogra S, Ishii N, Hashimoto T. Successful that these infants should be screened for neutropenia at birth until 6 months old.

(Submitted by Catherine Yang, MD)
use of rituximab in the treatment of childhood and juvenile pemphigus. J Am

Acad Dermatol. 2014 Oct;71:669-675.

Ogihara Y, Ogata S, Nomoto K, et al. Transcriptional regulation by inliximab

Rituximab has been increasingly used in the treatment of pemphigus in adults, therapy in Kawasaki disease patients with immunoglobulin resistance. Pe-

but until this article had only been reported in single case reports in children. diatr Res. 2014;76:287-293.

This series includes 10 patients (age 9-17 years) with pemphigus vulgaris and

pemphigus foliaceus treated at a single clinic in Chandigarh, India. All patients Recently, inliximab (IFX) has been used to treat Kawasaki disease (KD) pa-

tients with intravenous immunoglobulin (IVIG) resistance. However, the differ-
had some response to treatment, including 7/10 with complete response (CR)

and off therapy at an average of 21 weeks after start of treatment. Six of these ent mechanisms between IFX and IVIG therapies for KD remains unknown. The

patients relapsed at 8-20 months, but regained control of disease with either authors analyzed the transcript abundance proiles in whole blood from IFX-

steroids and azathioprine or another course of rituximab. Of the 3 patients who responsive KD subjects (who received IFX as the third-line treatment after two

did not reach CR off therapy by the end of the study, 1 patient had CR on therapy, cycles of IVIG) before and after IFX therapy. The pathway analysis showed that

1 had disease control, and the third had partial response on therapy. Infusion the expression levels of some transcripts associated with IVIG resistance were

reactions occurred in 4 patients, but were controlled, and no one had a late- changed by IFX therapy. Speciically, the levels of four transcripts (peptidase

inhibitor-3, MMP-8, chemokine receptor-2, and pentraxin-3) related to KD vas-
onset adverse event. Thus, treatment of childhood pemphigus with rituximab

shows promise. (Submitted by Carrie C. Coughlin, MD)
culitis and IVIG resistance decreased after IFX therapy. These indings provide

support for the use of IFX in KD patients with IVIG resistance.

Guiddir T, Frémond ML, Triki TB, et al. Anti–TNF- Therapy May Cause Neona- (Submitted by Kate Marks, DO)

tal Neutropenia. Pediatrics. 2014;134:e1189-e1193.

Shafferman A, Birmingham JD, Cron RQ. High dose anakinra for treatment of

Anti-TNF agents can cause agranulocytosis in adults and are known to cross severe neonatal Kawasaki disease: a case report. Pediatr Rheumatol Online

the placenta, but past registry studies have not observed neonatal complica- J. 2014;12:26-30.

tions. This article reports 4 newborn patients with severe neutropenia (absolute

neutrophil counts, ANC, < 0.5x109/L) born to two mothers treated with inliximab There are limited options for treating complications of Kawasaki disease. This

for ulcerative colitis during pregnancy. The ANC returned to normal within 8-14 article describes an 11 week-old female who developed severe acute Kawa-

weeks. Interestingly, the mothers did not have neutropenia themselves. Two of saki disease, and failed three doses of intravenous immunoglobulin (IVIG), aspi-

the infants developed supericial skin infections with Staphylococcus epider-
rin and high dose glucocorticoids. When her condition decompensated rapidly,

24 SOCIETY FOR PEDIATRIC DERMATOLOGY  www.pedsderm.net