Secondary Autoimmune Dermatological Disorders Induced by Multiple Sclerosis Biological Immunotherapy Agents: A Systematic Review of Case Reports.

Context: Multiple sclerosis (MS) is a devastating autoimmune neurodegenerative disease, for which disease-modifying drugs (DMDs) have been associated with secondary autoimmune dermatological disorders. Objectives: This systematic review of case reports seeks to examine documented case reports involving biological medications utilized in managing MS attacks and disease progression that correlate with such dermatological complications. Evidence Acquisition: A systematic search was conducted in the Google Scholar, Scopus, and PubMed databases for studies published until January 2024. The search strategy employed combinations of keywords such as "multiple sclerosis" with specific biological agents ("Natalizumab" OR "Ocrelizumab" OR "Rituximab" OR "Alemtuzumab" OR "Ofatumumab" OR "Ublituximab") and "case report", incorporating relevant Medical Subject Headings (MeSH) terms. All articles, if full texts were available, on case reports and case series of autoimmune dermatological complications of biological medication of MS were analyzed. The quality of the case reports was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. Results: A total of 19 articles fulfilled the inclusion criteria and were included in this review. The highest frequency of secondary autoimmune complications was documented with alemtuzumab administration, whereas rituximab demonstrated the lowest incidence of dermal autoimmune manifestations in MS patients. Conclusions: The employed injectable MS immunotherapies demonstrate various autoimmune adverse reactions that have been documented across numerous case reports. This review examines different categories of secondary autoimmune complications and explores the theoretical mechanisms underlying their development.