Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2013:79:3;432-433
doi: 10.4103/0378-6323.110788
PMID: 23619454

Etanercept-induced hypertriglyceridemia during the treatment of recurrent aphthous stomatitis

Marcos A Gonzalez-Lopez1 , Ricardo Blanco2 , Carmen Garcia-Ibarbia3 , Carmen M Gonzalez-Vela4 , Miguel A Gonzalez-Gay2
1 Department of Dermatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla s/n, Santander, Spain
2 Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla s/n, Santander, Spain
3 Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla s/n, Santander, Spain
4 Department of Pathology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Avenida de Valdecilla s/n, Santander, Spain

Correspondence Address:
Marcos A Gonzalez-Lopez
Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, IFIMAV. Avenida de Valdecilla s/n, E 39008. Santander
Spain
How to cite this article:
Gonzalez-Lopez MA, Blanco R, Garcia-Ibarbia C, Gonzalez-Vela CM, Gonzalez-Gay MA. Etanercept-induced hypertriglyceridemia during the treatment of recurrent aphthous stomatitis. Indian J Dermatol Venereol Leprol 2013;79:432-433
Copyright: (C)2013 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Tumor necrosis factor alpha (TNF-α) is known to play an important role in the lipid homeostasis. [1] However, the effects of TNF-α inhibition on circulating lipids remain controversial. [2] In this regard, a case of hypertriglyceridemia (HTG) associated with the soluble TNF-α receptor etanercept in a patient with psoriasis has recently been reported. [3] The HTG was also described in psoriasis patients following treatment with the anti-TNF-α monoclonal antibodies, such as infliximab [4] and adalimumab. [5] We report a new case of etanercept-induced HTG during treatment of recurrent aphthous stomatitis (RAS). A 34-year-old non-obese man presented with a 15-year history of recalcitrant recurrent aphthous stomatitis (RAS). Eight to ten new recurrent lesions occurred every 2 weeks. They healed without scarring in approximately 12 days. They were very painful (subjective pain severity of 8; scale, 1-10) and caused dysphagia. Treatment with topical and systemic corticosteroids only yielded slight improvement of symptoms. Previous treatments, such as tetracyclines, acyclovir, sulfones, colchicines, and thalidomide, had to be discontinued due to lack of efficacy or intolerance. Different conditions that may present with RAS such as Behηet΄s disease, gastrointestinal disorders, nutritional deficiencies, human immunodeficiency virus, and herpes simplex virus infection were excluded. In February 2010, he started the treatment with etanercept (25 mg twice weekly). Before the onset of this therapy, complete laboratory studies such as lipid profile and chest X-ray did not show abnormalities. The tuberculin skin test shows negative. Significant clinical improvement was observed after 4 weeks of etanercept therapy. However, a routine blood test revealed high triglyceride (TG) levels (291 mg/dl; normal <200). After eight weeks of treatment, the TG levels rose to 529 mg/dl; high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterols were within normal ranges. There was no family history of hyperlipidemia, diabetes, or other predisposing factors known to influence lipid metabolism.

Taken together, etanercept was considered as a potential-triggering factor for HTG and, because of that, this drug was discontinued. One month after etanercept withdrawal, the TG levels returned to the normal range. However, two months later the etanercept was reintroduced because of a new relapse. Four weeks later, high plasma TG level (852 mg/dl) were observed. Despite having very high TG levels the patient declined discontinuation of etanercept because of the improvement of the RAS. Consequently, gemfibrozil therapy (900 mg/daily) was started, leading to a remarkable decrease in TG levels. There are a number of reasons to consider that HTG in our patient was caused by etanercept, namely, (i) the close temporal relationship between the initiation of etanercept and the onset of HTG, (ii) its resolution following etanercept withdrawal, and (iii) the new increase of TG when etanercept therapy was reintroduced. To our knowledge, this is the first report of HTG associated with etanercept in a non-psoriatic patient. We also want to emphasize the efficacy of etanercept in the treatment of RAS, which has scarcely been documented in the literature. [6] The TNF-α acts on lipoprotein metabolism by increasing LDL and TG. [1],[5] However, the effects of TNF-α blockers on lipids are unclear. Several studies have shown improvement in the lipid pattern with decrease of TG and increase of HDL serum levels. However, a trend toward an atherogenic profile following treatment with anti-TNF-α antibodies has also been described. [1],[2],[5] Garces et al. have reported a lower atherogenic lipid profile in etanercept-treated patients than in infliximab-treated patients. [7] These authors reported that after 1 year of treatment with etanercept, there was a significant increase in HDL and no significant changes in total cholesterol or LDL levels. Furthermore, improvement in TG levels was observed after etanercept use. [7] The different effect on lipid profile of etanercept and other anti-TNF-α were proposed to be related to an additional blockage of lymphotoxin-α mediated by etanercept, leading to a less pro-atherogenic profile. [7] Nevertheless, our patient developed an HTG following treatment with this drug. The reasons for our findings are unknown. With respect to this, it is important to keep in mind that etanercept may have effects on other cytokines involved in the lipid homeostasis. With respect to this, both α- and γ-interferons increase the TG levels. [8] Interestingly, an up-regulation of both α- and γ-interferons has been disclosed in patients treated with etanercept. [9],[10] Therefore, it is possible that in predisposed individuals etanercept might lead to an over-production of some cytokines that can alter the lipid metabolism and increase the serum TG. In summary, lipid profile should be closely monitored during anti-TNF-α therapy. When TG levels exceed 400 mg/dl, drugs aim to lower TG should be added to prevent further complications.

References
1.
Chen X, Xun K, Chen L, Wang Y. TNF-α, a potent lipid metabolism regulator. Cell Biochem Funct 2009;27:407-16.
[Google Scholar]
2.
Pollono EN, Lopez-Olivo MA, Lopez JA, Suarez-Almazor ME. A systematic review of the effect of TNF-α antagonists on lipid profiles in patients with rheumatoid arthritis. Clin Rheumatol 2010;29:947-55.
[Google Scholar]
3.
Haroon M, Devlin J. Marked hypertriglyceridemia upon treatment with etanercept. Joint Bone Spine 2009;76:570-1.
[Google Scholar]
4.
Antoniou C, Dessinioti C, Katsambas A, Stratigos AJ. Elevated triglyceride and cholesterol levels after intravenous antitumour necrosis factor-alpha therapy in a patient with psoriatic arthritis and psoriasis vulgaris. Br J Dermatol 2007;156:1090-1.
[Google Scholar]
5.
Stinco G, Piccirillo F, Patrone P. Hypertriglyceridaemia during treatment with adalimumab in psoriatic arthritis. Br J Dermatol 2007;157:1273-4.
[Google Scholar]
6.
Robinson ND, Guitart J. Recalcitrant, recurrent aphthous stomatitis treated with etanercept. Arch Dermatol 2003;139:1259-62.
[Google Scholar]
7.
Garcês SP, Parreira Santos MJ, Vinagre FM, Roque RM, da Silva JA. Anti-tumour necrosis factor agents and lipid profile: A class effect? Ann Rheum Dis 2008;67:895-6.
[Google Scholar]
8.
Feingold KR, Grunfeld C. Role of cytokines in inducing hyperlipidemia. Diabetes 1992;41:97-101.
[Google Scholar]
9.
Mavragani CP, Niewold TB, Moutsopoulos NM, Pillemer SR, Wahl SM, Crow MK. Augmented interferon-alpha pathway activation in patients with Sjögren's syndrome treated with etanercept. Arthritis Rheum 2007;56:3995-4004.
[Google Scholar]
10.
Zou J, Rudwaleit M, Brandt J, Thiel A, Braun J, Sieper J. Up regulation of the production of tumour necrosis factor alpha and interferon gamma by T cells in ankylosing spondylitis during treatment with etanercept. Ann Rheum Dis 2003;62:561-4.
[Google Scholar]

Fulltext Views
2,315

PDF downloads
912
Show Sections