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Clinical Rheumatology Dec 2022Scleroderma is a rare complication in taxanes therapy. Although individual cases of taxanes-induced scleroderma have been reported, the clinical manifestation and... (Review)
Review
INTRODUCTION/OBJECTIVES
Scleroderma is a rare complication in taxanes therapy. Although individual cases of taxanes-induced scleroderma have been reported, the clinical manifestation and treatment outcomes were reviewed and summarized rarely. This study reported a patient who developed diffuse scleroderma and possible scleroderma renal crisis after paclitaxel therapy for ureter cancer.
METHOD
A PubMed literature review on published cases of taxanes-induced scleroderma up until April 2022 was included for analysis.
RESULTS
The search identified 27 patients with adequate information for analysis. Of the 28 patients, including the one presented here, 22 were female. Peripheral edema was the most common symptom in all but one patient, and often accompanied by erythema in 11. Symptoms usually occurred in half of the patients within the 4 course of treatment. Skin lesions gradually progressed to skin fibrosis, and extended proximally. Internal organ involvements were uncommon. Antinuclear antibody tests were positive occasionally, but anti-Scl70 and anti-centromere usually were negative. Taxanes therapy was discontinued, continued and unavailable in 21, 3, and 4 patients, respectively. Corticosteroids for skin lesions with or without immunosuppressive drugs were given to 15 patients. Of 25 patients with available skin outcomes, 19 improved. There was no significant skin improvement between those who did or did not receive skin treatment (62.5% vs. 75.0%, p = 0.37). Skin usually improved after discontinuing taxanes.
CONCLUSION
Taxanes-induced scleroderma is different from idiopathic scleroderma. Physicians should be aware of this condition in order to provide early diagnosis and apply appropriate management in order to avoid serious complications from severe skin sclerosis. Key Points • Scleroderma is a rare but unique and serious complication of taxanes therapy • Skin manifestations and distribution are similar to idiopathic scleroderma, but vascular phenomenon, internal organ involvement and scleroderma-associated auto-antibodies are presented rarely. Skin improvement usually occurs shortly after discontinuing taxanes • The role of immunosuppressive therapy in treating taxanes-induced scleroderma is not clear.
Topics: Humans; Female; Male; Paclitaxel; Scleroderma, Diffuse; Taxoids; Scleroderma, Localized; Scleroderma, Systemic; Acute Kidney Injury; Erythema
PubMed: 36085204
DOI: 10.1007/s10067-022-06364-z -
Annals of the Rheumatic Diseases Oct 2016
Topics: Humans; Scleroderma, Diffuse; Scleroderma, Systemic
PubMed: 27221693
DOI: 10.1136/annrheumdis-2016-209116 -
Proceedings of the Royal Society of... Jul 1953
Topics: Humans; Scleroderma, Diffuse; Scleroderma, Localized; Scleroderma, Systemic
PubMed: 13074204
DOI: No ID Found -
Annals of the Rheumatic Diseases May 2021American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS) is a composite endpoint to assess the likelihood of improvement in diffuse...
New composite endpoint in early diffuse cutaneous systemic sclerosis: revisiting the provisional American College of Rheumatology Composite Response Index in Systemic Sclerosis.
OBJECTIVES
American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS) is a composite endpoint to assess the likelihood of improvement in diffuse systemic sclerosis. ACR-CRISS is a weighted score and includes five core set measures: modified Rodnan skin score, FVC% predicted, health assessment questionnaire-disability index, and patient and clinician global assessments.
METHODS
We analysed core set measures from 354 participants who participated in three placebo-controlled trials. We generated 10 development datasets, randomly selected from 2/3 of the participants, stratified by study and treatment group. The remaining participants (1/3 of the participants) formed the validation sets. Risk differences (RDs) between active and placebo treatments were calculated by averaging over the replicate datasets; bootstrap 95% CIs for the RDs to estimate the magnitude of treatment effects.
RESULTS
In the development sets (n=237), the proportion of participants in the active group had statistically higher improvement in >1 of 5 core set measures versus the placebo group. For example, the proportion who improved by ≥20% in ≥3 core set measures was 49.4% in the active versus338.9% in the placebo; RD: 10.5%, 95% CI4.9 % to 16.1%. In the validation sets (n=117), the proportion who improved by ≥20% in ≥3 core set measures was 50.3% in the active versus35.63% in the placebo (RD:114.8%, 95% CI 3.1% to225.7%). Similar trends were seen with larger percentage cut-offs.
CONCLUSION
Revised CRISS, as assessed by the proportion of participants who improved by a certain percentage in ≥3 of 5 core set measures, is a potential new composite outcome measure.
Topics: Adult; Antirheumatic Agents; Disability Evaluation; Double-Blind Method; Female; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Rheumatology; Scleroderma, Diffuse; Scleroderma, Systemic; Severity of Illness Index; Treatment Outcome; United States
PubMed: 33257497
DOI: 10.1136/annrheumdis-2020-219100 -
Texas State Journal of Medicine Jan 1950
Topics: Basidiomycota; Humans; Scleroderma, Diffuse; Scleroderma, Localized; Scleroderma, Systemic
PubMed: 15399979
DOI: No ID Found -
Saudi Journal of Kidney Diseases and... 2018
Topics: Antihypertensive Agents; Humans; Hypertension, Renal; Kidney Diseases; Male; Middle Aged; Photopheresis; Plasma Exchange; Renal Dialysis; Scleroderma, Diffuse; Treatment Outcome
PubMed: 29456236
DOI: 10.4103/1319-2442.225189 -
JAMA Dermatology Dec 2013
Topics: History, 19th Century; History, 20th Century; Humans; Mesentery; Organotherapy; Scleroderma, Diffuse
PubMed: 24352719
DOI: 10.1001/jamadermatol.2013.5877 -
Rheumatic Diseases Clinics of North... Feb 2008Skin sclerosis is a clinical hallmark of systemic sclerosis (SSc) and provides a means to classify and evaluate patients. In the diffuse cutaneous subset, skin... (Review)
Review
Skin sclerosis is a clinical hallmark of systemic sclerosis (SSc) and provides a means to classify and evaluate patients. In the diffuse cutaneous subset, skin involvement is often extensive and warrants direct therapy. Currently, broad spectrum immunosuppressive strategies are used, but more targeted specific approaches are now emerging. This article reviews the evidence for efficacy of current treatment approaches and future developments for managing skin disease in early diffuse cutaneous SSc.
Topics: Antilymphocyte Serum; Fibrosis; Humans; Immunosuppressive Agents; Immunotherapy; Photopheresis; Scleroderma, Diffuse; Severity of Illness Index
PubMed: 18329538
DOI: 10.1016/j.rdc.2007.11.005 -
The Journal of Tropical Medicine and... Feb 1962
Topics: Basidiomycota; Humans; Medical Records; Scleroderma, Diffuse; Scleroderma, Localized; Scleroderma, Systemic
PubMed: 14461917
DOI: No ID Found -
Krankenpflege. Soins Infirmiers 2007
Topics: Connective Tissue Diseases; Humans; Scleroderma, Diffuse; Scleroderma, Limited; Scleroderma, Localized; Skin Diseases
PubMed: 17760381
DOI: No ID Found