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 23 May 2018

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News

Autoimmunity associated with anti-tumor necrosis factor alpha treatment

Researchers in the July issue of Gastroenterology find that the cumulative incidence of antinuclear antibodies after 24 months, in a cohort of infliximab-treated Crohn's disease patients, is 57%.

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Infliximab therapy is effective for treating Crohn’s disease.

However, the development of antinuclear antibodies has been reported in patients with infliximab. The magnitude of this problem and the relationship with autoimmunity are not clear.

In this study, researchers from Belgium evaluated the occurrence of antinuclear antibodies in 125 consecutive Crohn’s patients, and the relationship with symptoms of autoimmunity.

The team investigated autoantibodies and clinical data before and after infliximab infusion.

More than 75% became antinuclear antibody positive after fewer than 3 infusions.
Gastroenterology

If the team determined that the antinuclear antibodies were 1:80, they performed a further study of double-stranded DNA, single-stranded DNA, histones, and ENA.

The research team found that the cumulative antinuclear antibody incidence at 24 months was 57%.

They determined that almost half of the patients developed antinuclear antibodies after their first infusion. More than 75% became antinuclear antibody positive after fewer than 3 infusions.

After a median of 12 months, the team found that only 15 of 71 patients had become seronegative.

Of 43 antinuclear antibody-positive patients who were further subtyped, 33% had double-stranded DNA, 40% had single-stranded DNA, 21% had antihistone, and 0% were ENA positive.

The researchers identified 2 patients who developed drug-induced lupus without major organ damage. Of these, 1 developed autoimmune hemolytic anemia.

The team determined that antinuclear antibodies were associated with the female sex (odds ratio, 3.2), and with papulosquamous or butterfly rash (odds ratio, 10.0).

Dr Severine Vermeire's team concluded, "The cumulative incidence of antinuclear antibodies was 57% after 24 months in this cohort of infliximab-treated Crohn’s disease patients".

"Antinuclear antibodies persisted up to 1 year after the last infusion, and only a few patients became seronegative".

"Two patients developed drug-induced lupus erythematosus".

"Antinuclear antibodies were associated with the female sex and skin manifestations".

Gastroenterology 2003; 125(1): 32-9
10 July 2003

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