Conflicts of interest The author declares no conflict of interest.
Efficacy of tumour necrosis factor-α antagonists in aphthous ulceration: review of published individual patient data
Article first published online: 24 MAR 2011
© 2011 The Author. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 26, Issue 2, pages 231–235, February 2012
How to Cite
O’Neill, I.D. (2012), Efficacy of tumour necrosis factor-α antagonists in aphthous ulceration: review of published individual patient data. Journal of the European Academy of Dermatology and Venereology, 26: 231–235. doi: 10.1111/j.1468-3083.2011.04041.x
Funding declaration The author declares that this study was not funded by any government agency or commercial sponsor.
- Issue published online: 26 JAN 2012
- Article first published online: 24 MAR 2011
- Received: 21 October 2010; Accepted: 14 February 2011
Background Severe aphthous ulceration may require systemic immunosuppressive or immunomodulatory therapy, but a small subset of patients remains resistant to or intolerant of these agents. Although use of TNF-α antagonists in aphthous ulceration is increasingly reported, the current evidence base for use is weak and evaluation of individual cases may provide the best available data to support such use.
Objectives The aim of this study was to review all published data on the use of TNF-α antagonists in patients with severe aphthous ulceration refractory to systemic agents and discusses this in the context of any possible benefits that may guide any future use.
Methods A comprehensive search on MEDLINE and EMBASE from 1995 to 2010 was performed using pre-defined search terms, with articles included if they met specific criteria.
Results Sixteen cases from individual case reports or small case-series in which use of TNF-α antagonists in aphthous ulceration were identified in which details of previous systemic therapy and use of subsequent adjunctive therapy were available. Agents with reported success in resolving active ulceration and reducing ulcer recurrence were infliximab, etanercept and adalimumab.
Conclusions Evidence for efficacy of TNF-α antagonists in aphthous ulceration infection is limited. Such data suggest that in patients with severe aphthous ulceration TNF-α antagonists have some efficacy in inducing ulcer resolution and reducing recurrence. These agents may represent an option in severe refractory aphthosis, although in the absence of controlled studies, caution is advocated if use is to be considered.