Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: a retrospective study.
OBJECTIVE
Several paradoxical adverse events (PAEs), e.g. IBDs, acute anterior uveitis (AAU) and psoriasis, have been described in patients taking anti-TNF drugs. This retrospective study aimed to describe the different PAEs that have occurred in a population of SpA patients treated with anti-TNF drugs, and to determine whether they are drug specific.


METHODS
Since 2000, we have followed 296 patients with SpA [198 AS, 21 SpA associated with IBD (9 ulcerative colitis, 12 Crohn's disease) and 77 psoriatic arthritis] treated with at least one anti-TNF drug (infliximab, etanercept or adalimumab), and 112 SpA patients treated only with conventional DMARDs who served as controls. Considering the cumulative time of exposure to each anti-TNF agent, the frequencies of new-onset PAEs in exposed patients were calculated.


RESULTS
Respective cumulative exposure times were 287, 290 and 62 patient-years for infliximab, etanercept and adalimumab. We observed the following PAEs: five psoriasis (three under infliximab and one with etanercept or adalimumab), three AAU (1/100 patient-years, all under etanercept) and four IBD (three under etanercept and one under infliximab). There was no significant association among any of these PAEs and a specific anti-TNF agent; nor significant difference in the overall PAEs among patients receiving anti-TNF drugs or controls (P = 0.303), the latter experiencing two psoriasis and three AAU.


CONCLUSIONS
Undesirable side effects--IBD, AAU and psoriasis--may appear with anti-TNF drugs. Even if they are, a priori, paradoxical, no evidence supports any PAEs to be anti-TNF agent-specific in SpA.
Fouache
Damien
D
Department of Pharmacy, University of Medicine-Pharmacy, Rouen University Hospital and Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, Rouen,France.
Goëb
Vincent
V
Massy-Guillemant
Nathalie
N
Avenel
Gilles
G
Bacquet-Deschryver
Helene
H
Kozyreff-Meurice
Macha
M
Ménard
Jean-François
JF
Muraine
Marc
M
Savoye
Guillaume
G
Le Loët
Xavier
X
Tharasse
Christine
C
Vittecoq
Olivier
O
D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D015535:Arthritis, Psoriatic / Q000139:chemically induced; D003093:Colitis, Ulcerative / Q000139:chemically induced; D003424:Crohn Disease / Q000139:chemically induced; D004334:Drug Administration Schedule; D000068800:Etanercept; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced*; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D025242:Spondylarthropathies / Q000188:drug therapy* / Q000276:immunology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014606:Uveitis, Anterior / Q000139:chemically induced
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept