Skin Reactions in Patients With Multiple Sclerosis Receiving Cladribine Treatment
Rolfes L, Pfeuffer S, Hackert J, Pawlitzki M, Ruck T, Sondermann W, Korsen M, Wiendl H, Meuth SG, Kleinschnitz C, Pul R (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Book Volume: 8
Article Number: e990
Journal Issue: 3
DOI: 10.1212/NXI.0000000000000990
Abstract
ObjectiveTo report 77 patients with multiple sclerosis (MS) who developed skin-related adverse events (AEs) following treatment with cladribine.MethodsWe evaluated our prospective bicentric cladribine cohort. Cladribine-treated patients with a skin AE were identified.ResultsTwo 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.ConclusionSkin 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 EvidenceThis study provides Class IV evidence that skin-related AEs are frequent in patients with MS following cladribine in a real-world setting.
Involved external institutions
Universitätsklinikum Münster
Germany (DE)
Universitätsklinikum Essen
Germany (DE)
Universitätsklinikum Düsseldorf
Germany (DE)
Germany (DE)
Universitätsklinikum Essen
Germany (DE)
Universitätsklinikum Düsseldorf
Germany (DE)
How to cite
APA:
Rolfes, L., Pfeuffer, S., Hackert, J., Pawlitzki, M., Ruck, T., Sondermann, W.,... Pul, R. (2021). Skin Reactions in Patients With Multiple Sclerosis Receiving Cladribine Treatment. Neurology, Neuroimmunology and Neuroinflammation, 8(3). https://doi.org/10.1212/NXI.0000000000000990
MLA:
Rolfes, Leoni, et al. "Skin Reactions in Patients With Multiple Sclerosis Receiving Cladribine Treatment." Neurology, Neuroimmunology and Neuroinflammation 8.3 (2021).
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