Characterization of patients with infliximab-induced lupus erythematosus and outcomes after retreatment with a second anti-TNF agent.
BACKGROUND
Drug-induced lupus erythematosus (DILE) due to infliximab therapy for inflammatory bowel disease (IBD) is an uncommon occurrence. It remains uncertain whether patients with infliximab-induced DILE could tolerate another antitumor necrosis factor (TNF) agent without recurrent DILE.


METHODS
We reviewed the case records of patients with infliximab-induced DILE diagnosed at our institute and noted details of their clinical and immunological profile at presentation. In addition, case notes of patients who were treated with a second anti-TNF agent were examined for evidence of recurrent DILE.


RESULTS
Thirteen patients with infliximab-induced DILE were identified with a female-to-male ratio of 11:2. Symmetric large joint arthralgias and high titers of antinuclear and antidouble-stranded DNA antibody were noted in all patients. Eight patients were retreated with a second anti-TNF agent (six certolizumab pegol and two adalimumab) of whom two patients (one adalimumab and certolizumab pegol each) developed recurrent DILE following 3 months of therapy with a second anti-TNF agent. One patient discontinued therapy after 2 months despite no recurrence of DILE, due to fear of side effects. Five patients remain well with no recurrence of DILE after a median of 5 months (range 2-6) therapy.


CONCLUSIONS
Rechallenge with a further anti-TNF agent in patients who have developed DILE with infliximab is associated with a low rate of recurrence.
Subramanian
Sreedhar
S
Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK. sreedhar.subramanian@rlbuht.nhs.uk
Yajnik
Vijay
V
Sands
Bruce E
BE
Cullen
Garret
G
Korzenik
Joshua R
JR
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D001323:Autoantibodies / Q000276:immunology; D015331:Cohort Studies; D004247:DNA / Q000097:blood / Q000276:immunology; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055502:Secondary Prevention; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D004247:DNA; D000069285:Infliximab