An 8-year-old boy with general pustular psoriasis (GPP) and iatrogenic secondary Cushing syndrome was treated successfully with etanercept after he had failed on acitretin, methotrexate, and methylprednisolone therapy. GPP is a severe and very rare variant of psoriasis in children often accompanied by life-threatening complications. Retinoids, cyclosporine, methotrexate, or dapsone used in a small number of case series and case reports were effective. Etanercept is a recombinant human tumor necrosis factor-alpha (TNF-alpha) receptor protein fused with Fc portion of IgG1 that binds to TNF-alpha, approved by Food and Drug Administration for the treatment of moderate-to-severe plaque psoriasis in children and teens who have not responded to other psoriasis treatments. In our patient, etanercept demonstrated significant clinical response associated with long-term efficacy without acute exacerbation, excellent tolerability, and good safety profile.

• Klíčová slova
• childhood generalized pustular psoriasis, etanercept, juvenile generalized pustular psoriasis,
• MeSH
• časové faktory MeSH
• etanercept MeSH
• imunoglobulin G škodlivé účinky   terapeutické užití   MeSH
• imunosupresiva škodlivé účinky   terapeutické užití   MeSH
• indukce remise MeSH
• lidé MeSH
• mladiství MeSH
• psoriáza diagnóza   farmakoterapie   MeSH
• receptory TNF terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• etanercept MeSH
• imunoglobulin G MeSH
• imunosupresiva MeSH
• receptory TNF MeSH

With the growing number of patients with immune-modulated diseases treated with tumor necrosis factor (TNF) alpha inhibitors, we are more frequently encountering the occurrence of so-called paradoxical drug reactions. These are basically situations where during the course of the treatment of one disease, the manifestation of another with similar etiopathogenesis occurs, although under normal conditions this newly developed disease responds well to treatment with TNF alpha inhibitors and is indicated for this treatment. Skin reactions are most frequently recorded in the form of induced psoriasis and psoriasiform exanthems. A less common paradoxical reaction is the induction of Crohn's disease, which is most often described in association with the treatment of inflammatory joint diseases with etanercept. We present a case of induction of Crohn's disease during therapy with etanercept, where the primary disease being treated was psoriasis. In the literature, similar cases have only been described sporadically.

• Klíčová slova
• Crohn's disease, paradoxical drug reaction (etanercept), psoriasis,
• MeSH
• Crohnova nemoc chemicky indukované   MeSH
• dospělí MeSH
• etanercept MeSH
• imunoglobulin G škodlivé účinky   terapeutické užití   MeSH
• imunologické faktory škodlivé účinky   terapeutické užití   MeSH
• lidé MeSH
• psoriáza farmakoterapie   patologie   MeSH
• receptory TNF terapeutické užití   MeSH
• stupeň závažnosti nemoci MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• etanercept MeSH
• imunoglobulin G MeSH
• imunologické faktory MeSH
• receptory TNF MeSH
• TNF-alfa MeSH

Juvenile idiopathic arthritis (JIA) is an inflammatory disease associated with bone loss and low bone mineral density (BMD). The treatment involves disease-modifying antirheumatic drugs, glucocorticoids (GCs) and biological agents. The aim of this study was to evaluate effects of 12-month therapy with the anti-tumor necrosis factor alpha (anti-TNFα) preparations on bone mineral density (BMD) and biochemical turnover markers (BTM) in adult patients with JIA who were previously either treated or not treated with glucocorticoids (GC) and to assess effects of the discontinuation of GCs on their bone status. Nineteen adult patients (12 women, 7 men) aged 18-33 years with active JIA were prospectively enrolled to receive the anti-TNFα therapy (infliximab, etanercept or adalimumab). BMD and BTMs were determined at baseline and 1-year follow-up. The anti-TNFα therapy resulted in a significant reduction in disease activity score 28 (DAS28) and C-reactive protein (CRP) and a significant increase in BMD at the lumbar spine and total body and in serum N-terminal propeptide of type I procollagen (PINP, marker of bone formation). No significant changes in serum beta C-terminal telopeptide of type I collagen (βCTX, marker of osteoclastic bone resorption) and osteocalcin (marker of bone remodeling) were found. A significant negative correlation was observed between the change in the DAS28, CRP and serum PINP. The change in serum PINP concentrations positively correlated with the change in lumbar spine BMD. A significant increase in serum PINP was observed only in patients discontinuing GCs during the anti-TNFα treatment. After the initiation of the anti-TNFα therapy in young adults with JIA, the increase in new bone formation can be explained by discontinuation of GCs administration as the patients with the largest reduction in DAS28 and CRP probably are the ones most likely to stop GC.

• MeSH
• adalimumab MeSH
• antirevmatika farmakologie   terapeutické užití   MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• dospělí MeSH
• etanercept MeSH
• humanizované monoklonální protilátky farmakologie   terapeutické užití   MeSH
• imunoglobulin G farmakologie   terapeutické užití   MeSH
• infliximab MeSH
• juvenilní artritida krev   diagnostické zobrazování   farmakoterapie   MeSH
• kolagen typu I krev   MeSH
• kosti a kostní tkáň diagnostické zobrazování   účinky léků   MeSH
• kostní denzita účinky léků   MeSH
• lidé MeSH
• mladiství MeSH
• monoklonální protilátky farmakologie   terapeutické užití   MeSH
• osteokalcin krev   MeSH
• prokolagen krev   MeSH
• radiografie MeSH
• receptory TNF terapeutické užití   MeSH
• remodelace kosti účinky léků   MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• adalimumab MeSH
• antirevmatika MeSH
• biologické markery MeSH
• C-reaktivní protein MeSH
• etanercept MeSH
• humanizované monoklonální protilátky MeSH
• imunoglobulin G MeSH
• infliximab MeSH
• kolagen typu I MeSH
• monoklonální protilátky MeSH
• osteokalcin MeSH
• prokolagen MeSH
• receptory TNF MeSH
• TNF-alfa MeSH

INTRODUCTION: Severe forms of psoriasis are indicated for systemic treatment with conventional and biological preparations. The former includes methotrexate, cyclosporin, acitretin and narrow-band ultraviolet B phototherapy but toxicity may limit the dose and duration of treatment. Currently used less toxic biological preparations include inhibitors of TNF-alpha (etanercept, adalimumab, infliximab) and the monoclonal antibody against IL 12/23 ustekinumab. We present our own more than five-year experience with the systemic treatment of severe forms of psoriasis using these preparations. METHODS: A total of 66 patients treated with systemic therapy (except for phototherapy) were divided into groups based on treatment. Therapeutic doses were administered according to the recommendations of the manufacturer and dermatological societies. Standard PASI and BSA indexes were used to evaluate clinical condition at weeks 0, 12 and 24. RESULTS: Differences in PASI score reduction and BSA index between patient groups treated with different preparations were statistically significant at monitored intervals. At week 12, PASI score was reduced by 75% or more in a significantly greater number of patients treated with infliximab + methotrexate than those treated with acitretin. At week 24, identical comparison showed a significantly greater number of patients treated with etanercept or adalimumab than those receiving methotrexate. For BSA index reduction by 50% or more, no statistically significant differences were found between patient groups during the follow-up period. CONCLUSION: Systemic therapy provides a significant benefit to patients with severe psoriasis. Biological preparations are more effective than conventional medications which are often limited by severe side-effects and generally less tolerated than biological treatments.

• MeSH
• adalimumab MeSH
• etanercept MeSH
• humanizované monoklonální protilátky terapeutické užití   MeSH
• imunoglobulin G terapeutické užití   MeSH
• infliximab MeSH
• lidé středního věku MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• psoriáza farmakoterapie   patologie   MeSH
• receptory TNF terapeutické užití   MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• ustekinumab MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• Názvy látek
• adalimumab MeSH
• etanercept MeSH
• humanizované monoklonální protilátky MeSH
• imunoglobulin G MeSH
• infliximab MeSH
• monoklonální protilátky MeSH
• receptory TNF MeSH
• TNF-alfa MeSH
• ustekinumab MeSH

A comparison of effectiveness of TNF antagonists adalimumab, infliximab and etanercept in the treatment of rheumatoid arthritis (RA) was made, which was derived from studies provided abroad based on routine clinical practice. The calculation of cost-effectiveness of each TNF antagonist for Czech Republic was made on the basis of Dutch DREAM registry of patients with RA (Kiewit et al, 2008). The prices of therapy of all three TNF antagonists are similar in the first year of treatment of patients with average weight, in the second year the price of infliximab is lower, but only in the case of patients where the doses do not reach 4 amp. of infliximab. Clinical effectiveness was evaluated in DAS28 and HAQ units. Cost-effectiveness of all TNF antagonists was similar, when 2 amp. of infliximab per dose phycician considered sufficient, but when patients were given higher doses of infliximab the trend to lower cost-effectiveness of infliximab compared to adalimumab and etanercept was observed.

• MeSH
• adalimumab MeSH
• analýza nákladů a výnosů MeSH
• antirevmatika ekonomika   terapeutické užití   MeSH
• etanercept MeSH
• humanizované monoklonální protilátky MeSH
• imunoglobulin G ekonomika   terapeutické užití   MeSH
• infliximab MeSH
• lidé MeSH
• monoklonální protilátky ekonomika   terapeutické užití   MeSH
• receptory TNF terapeutické užití   MeSH
• revmatoidní artritida farmakoterapie   ekonomika   MeSH
• TNF-alfa antagonisté a inhibitory   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• adalimumab MeSH
• antirevmatika MeSH
• etanercept MeSH
• humanizované monoklonální protilátky MeSH
• imunoglobulin G MeSH
• infliximab MeSH
• monoklonální protilátky MeSH
• receptory TNF MeSH
• TNF-alfa MeSH