Title:Development of Morphea Following Treatment with an ADA Biosimilar:
A Case Report
Volume: 20
Issue: 4
Author(s): Aliki I. Venetsanopoulou, Konstantina Mavridou, Eleftherios Pelechas, Paraskevi V. Voulgari and Alexandros A. Drosos*
Affiliation:
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina,
Greece
Keywords:
Morphea, localized scleroderma, TNFα inhibitors, TNFi biosimilar, adalimumab biosimilar, psoriasis.
Abstract:
Background: Tumor necrosis factor alpha (TNFα) is a pivotal cytokine involved in the
pathogenesis of certain inflammatory diseases, such as rheumatoid arthritis (RA), spondyloarthropathies,
and inflammatory bowel diseases. In the last two decades, TNFα inhibitors (TNFi) have
revolutionized the treatment and outcome of the above disorders. However, the use of TNFi has
been associated with the development of many autoimmune phenomena and paradoxical skin manifestations
that may present as the same type of clinical indications for which the TNFi effectively
used. Thus, they may display as arthritis, uveitis, colitis, psoriasis, and several other cutaneous
clinical manifestations, among them the development of morphea, a localized scleroderma skin lesion.
Case Presentation: We describe a 58-year-old woman with seronegative RA, refractory to
methotrexate, who was treated with ABP-501 (Hefiya), an adalimumab (ADA) biosimilar and developed
an oval-shaped, deep skin lesion of approximately 3.5cm in size, affecting the left part of
her back compatible with morphea 3 months after the initiation of therapy. ADA biosimilar was
discontinued and two months later, she had substantial skin improvement.
Conclusion: This is the first report of morphea manifestation during TNFi biosimilar since the patient
had no other trigger factors for morphea development like trauma and infections. Physicians
dealing with patients treated with TNFi biosimilars should be aware of paradoxical skin reactions,
among them morphea; thus, close monitoring, a minute and careful clinical examination, and a follow-
up check are required.
