Localized Panniculitis and Subsequent Lipoatrophy with Subcutaneous Glatiramer Acetate (Copaxone®) Injection for the Treatment of Multiple Sclerosis
Tóm tắt
Glatiramer acetate (copolymer 1, Copaxone®) is a mixture of synthetic polypeptides and is used for the treatment of multiple sclerosis. It has been shown to possess beneficial effects in reducing the relapse rate in relapsing-remitting multiple sclerosis. Its main mechanism of action is regarded as a switch of the immune reaction from a T helper (Th)1 to a Th2 cell type. Glatiramer acetate is administered by subcutaneous injection once daily. As described in previous reports, the most common adverse effects are pain, inflammation, and induration at the injection site, occurring in approximately 20–60% of patients. A rare adverse effect is a localized lipoatrophy at the site of injection, which has previously been observed and described in 11 patients. It has been reported that these atrophic areas remain unchanged and localized lipoatrophy may be preceded by a subcutaneous panniculitis. In this article, we describe another case of subcutaneous changes following repeated glatiramer acetate injection, presented as localized panniculitis in the area around the injection sites, in a 46-year-old female patient who was treated with glatiramer acetate for 18 months.
Tài liệu tham khảo
Bornstein MB, Miller A, Slagle S, et al. A pilot trial of Cop 1 in exacerbating-remitting multiple sclerosis. N Engl J Med 1987; 317: 408–14
Mancardi GL, Murialdo A, Drago F, et al. Localized lipoatrophy after prolonged treatment with copolymer 1. J Neurol 2000; 247: 220–1
Ziemssen T, Neuhaus O, Farina C, et al. Behandlung der Multiplen Sklerose mit Glatiramer-Azetat. Nervenarzt 2002; 73: 321–31
Arnon S, Sela M, Teitelbaum D. New insights into the mechanism of action of copolymer 1 in experimental allergic encephalomyelitis and multiple sclerosis. J Neurol 1996; 243: 8–13
Aharoni R, Teitelbaum D, Arnon R, et al. Copolymer 1 acts against the immunodominant epitope 82–100 of myelin basic protein by T cell receptor antagonism in addition to major histocompatibility complex blocking. Proc Natl Acad Sci U S A 1999; 96: 634–9
Hohlfeld R, Kerschensteiner M, Stadelmann C, et al. The neuroprotective effect of inflammation: implications for the therapy of multiple sclerosis. J Neuroimmunol 2000; 107: 161–6
Drago F, Brusati C, Mancardi G, et al. Localized lipoatrophy after glatiramer acetate injection in patients with remitting-relapsing multiple sclerosis. Arch Dermatol 1999; 135: 1277–8
Hwang L, Orengo I. Lipoatrophy associated with glatiramer acetate injections for the treatment of multiple sclerosis. Cutis 2001; 68: 287–8