Naslov
Autoantibodies induced by infliximab treatment-two years follow up after infliximab was stopped

Autori
Novak, Srđan ; Anić, Branimir ; Čikeš, Nada ; Ravlić-Gulan, Jagoda ; Gulan, Gordan ; Bosnić, Dubravka

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Annals of Rheumatic Diseases 65 (suppl II) / Leo van de Putte - Nijmegen : BMJ, 2006

Skup
Annual European Congress of Rheumatology

Mjesto i datum
Amsterdam, Nizozemska, 21.06.2006. - 24.06.2006

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
rheumatoid arthritis; infliximab; autoantibodies

Sažetak
Background: Anti-TNF-alfa treatment can induce occurrence of autoantibodies (AA) in rheumatoid arhritis (RA) patients. In the majority of treated patients they have no clinical significance although several cases of drug induced lupus (DIL) have been described. It is not known how long those AA induced by anti-TNF therapy remain positive after TNF therapy was stopped, and if they have any clinical significance. Objectives: To evaluate presence and clinical significance of autoantibodies in RA patients treated with infliximab and methotrexate (MTX) after TNF therapy was stopped. Methods: 24 patients with active RA were treated with metotrexate and infliximab for one year. The dosage of infliximab was 3mg/kg given week 0, 2, 6 and every 8th week thereafter. Analyses for antinuclear antibodies (ANA), anti-doble-stranded DNA antibodies (anti-ds-DNA), antibodies to extractabele nuclear antigen (ENA) and anticardiolipin antibodies (ACLA) were performed during the treatment (at the baseline, at week 2, 6, 14, 22, 30, 38, 46 and 54), and consequently, after therapy was stopped, every 6 months for two years. Anti-ds-DNA, ENA and ACLA were done by ELISA. Results: 17 patients recieved nine infusions of infliximab, in other 7 inflliximab was discontinued earlier. All 24 patients were evaluated for AA two years after infliximab was stopped. At the baseline visit 3/24(12.5%) patients had positive ANA. At time when infliximab was stopped 16/24 (47.06%) was ANA postive. 24 months after last infusion 6/24 (25%) had still positive ANA. Before treatment no patients had anti-ds-DNA. At time when infliximab was stopped12/24 (50%) had anti-ds-DNA positive. 24 months after last dose of infliximab 3/24 (12.5%) patients had positive ant-ds-DNA.(See Table). The presence of AA decreased with the time from stopping the treatment. However, in a number of patients AA induced by infliximab continue to remain positive. One of our ANA negative RA patients developed clinical and laboratory signs of systemic lupus erythematosus(SLE)after 4th infusion. Since her condition improved after infliximab was stopped, diagnosis of DIL was reasonable. However, two years later this patient had still positive ANA and anti-ds-DNA and photosensitive face rash which suggests a SLE-RA overlaping unmasked by infliximab (This patient was reported earlier). All other patients that are ANA and anti-ds-DNA positive, even two years after infliximab was stooped, have no any other signs of SLE or overlapping sindroms. week 0 time infl. was stopped month 6 month 12 month 18 month 24 ANA 3/24 16/24 10/24 8/24 6/24 6/24 ANTI-ds-DNA 0/24 12/24 8/24 6/24 4/24 3/24 ENA 0/24 6/24 5/24 4/24 3/24 1/24 ACL 3/24 3/24 3/24 3/24 3/24 3/24 Conclusion: Treatment with infliximab induced antinuclear and anti-ds-DNA antibodies in high numbers of our patients during one year treatment with infliximab. In minority of them ANA and anti-ds-DNA were still positive after two years from stopping the treatment. With time the presence of AA diminished. In majority of patients in whom AA induced by infliximab remained positive after stopping infliximab have no clinical significance.

Izvorni jezik
Engleski

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