afamelanotide
Sources réglementaires consultées
Indications approuvées
- Prévention de la phototoxicité chez les adultes atteints de protoporphyrie érythropoïétique.
Contre-indications
Absolues
- Hypersensibilité, maladie hépatique grave ou insuffisance hépatique ou rénale.
Mises en garde cliniques
- Mise en garde majeure · Maintenir les mesures habituelles de photoprotection. Examiner toute la peau tous les 6 mois en raison du foncement possible des lésions pigmentées et du risque de cancer cutané ; les données de sécurité au-delà de 2 ans sont limitées. — CIMA SCENESSE 16 mg implante, registro 114969001
- Mise en garde majeure · Une hypersensibilité sévère, un angio-œdème et une anaphylaxie ont été rapportés après commercialisation. Ne pas réexposer ; le retrait de l’implant peut être nécessaire. — DailyMed SCENESSE implant, set ID 94f53286-11dd-7fbb-e053-2a95a90a7c48
- Mise en garde majeure · Surveiller étroitement les comorbidités non étudiées et utiliser avec prudence chez les patients ayant un mélanome ou des antécédents de cancer cutané. — CIMA SCENESSE 16 mg implante, registro 114969001
Interactions médicamenteuses
- ModéréeAnticoagulants, acide acétylsalicylique ou AINS
Mécanisme: Ils peuvent augmenter les ecchymoses ou le saignement au site de l’implant.
Recommandation: Surveiller le site d’implantation et le risque hémorragique.
https://cima.aemps.es/cima/dochtml/ft/114969001/FT_114969001.html
Effets indésirables
Communs (≥1%)
Céphalées · Nausées · Changement de couleur, douleur, hématome ou érythème au site de l’implant
Grossesse et allaitement
Ne pas utiliser pendant la grossesse ou l’allaitement. Utiliser une contraception efficace pendant le traitement et pendant 3 mois après.
Bibliographie récente (PubMed)
Vitiligo is a complex disease with a multifactorial nature and a high impact on the quality of life of patients. Although there are multiple therapeutic alternatives, there is currently no fully effective treatment for this disease. In the current era, multiple drugs are being developed for the treatment of autoimmune diseases. This review assesses the available evidence on the pathogenesis of vitiligo, and a comprehensive review of treatments available for vitiligo now and in the near future is provided. This qualitative analysis spans 116 articles. We reviewed the mechanism of action, efficacy and safety data of phototherapy, afamelanotide, cyclosporine, phosphodiesterase 4 inhibitors, trichloroacetic acid, basic fibroblast growth factor, tumor necrosis factor (TNF) inhibitors, secukinumab, pseudocatalase and janus kinase (JAK) inhibitors. At the moment, there is no clearly outstanding option or fully satisfactory treatment for vitiligo, so it is necessary to keep up the development of new drugs as well as the publication of long-term effectiveness and safety data for existing treatments. Afamelanotide is a melanocortin-1 receptor agonist that stimulates melanin production in the skin and is used to decrease pain and itching from light exposure in patients with erythropoietic protoporphyria and X-linked protoporphyria. Afamelanotide has not been linked to serum aminotransferase elevations during therapy nor to instances of idiosyncratic acute liver injury with symptoms and jaundice.
Vitiligo is a common disorder of depigmentation caused by the progressive destruction of melanocytes that affects the skin, hair, and mucous membranes, clinically presenting as depigmented macules and leukotrichia. This condition, affecting millions of people worldwide, has a significant psychosocial burden on patients' quality of life, particularly in relation to skin colour. The etiopathogenesis of this disorder is obscure, but multiple factors contribute to the loss of melanocytes in the skin, like oxidative stress, inflammation, genetics, and autoimmunity. The treatment of vitiligo has been challenging over the past years, but recent developments in understanding the etiopathogenesis of the disease have paved the way for the development of more effective and promising therapeutic treatment options. The aim of this review was to provide an overview of the underlying mechanisms and highlight the latest advances in the treatment of vitiligo. This review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalyses) guidelines. A comprehensive search of the literature was carried out through the PubMed electronic database from inception to 31 December 2023 using the following search terms "vitiligo" AND "JAK inhibitors", "vitiligo" AND "prostaglandin", " vitiligo" AND " afamelanotide", "vitiligo" AND "antioxidants", "vitiligo" AND "vitamin D3", "vitiligo" AND "statins", "vitiligo" AND "TNF-alpha", "vitiligo" AND "interleukin", "vitiligo" AND "light therapy". Two independent reviewers screened titles, abstracts, and full texts to select papers dealing with vitiligo and its treatment. The advent of treatment modalities like Janus kinase inhibitors, prostaglandin analogues, antioxidants, TNF-α inhibitors, targeted phototherapy, and excimer lasers has revolutionized the therapeutic possibilities, offering a ray of hope to the individuals suffering from this devastating condition.
Vitiligo is an acquired hypopigmentation of the skin due to a progressive selective loss of melanocytes; it has a prevalence of 1-2% and appears as rounded, well-demarcated white macules. The etiopathology of the disease has not been well defined, but multiple factors contribute to melanocyte loss: metabolic abnormalities, oxidative stress, inflammation, and autoimmunity. Therefore, a convergence theory was proposed that combines all existing theories into a comprehensive one in which several mechanisms contribute to the reduction of melanocyte viability. In addition, increasingly in-depth knowledge about the disease's pathogenetic processes has enabled the development of increasingly targeted therapeutic strategies with high efficacy and fewer side effects. The aim of this paper is, by conducting a narrative review of the literature, to analyze the pathogenesis of vitiligo and the most recent treatments available for this condition.