title: Autoantibodies in psoriasis as predictors for loss of response and anti-infliximab antibody induction.
abstract: BACKGROUND
  Infliximab is successfully used to treat psoriasis and psoriatic arthritis. However, some patients lose therapeutic response after several cycles. Antibodies to infliximab (infliximab-Abs) are induced during treatment in a subgroup of patients and are thought to be associated with loss of response (LOR). Routine screening for infliximab-Abs is expensive and not regularly performed. A reliable and affordable method for identifying patients who are at risk for LOR to infliximab is desirable.
  
  
  OBJECTIVE
  To analyse the development of antinuclear antibodies (ANA)/antidouble-stranded DNA antibodies (anti-dsDNA) over time in patients with psoriasis receiving infliximab. To analyse if there is an association between ANA titres/anti-dsDNA concentrations, infliximab-Ab status and LOR.
  
  
  METHODS
  A retrospective data analysis of 29 patients with psoriasis receiving infliximab was carried out. ANA titres and anti-dsDNA concentrations were regularly monitored in these patients and sera were tested for infliximab-Abs by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Median ANA titres increased from 1 : 80 [interquartile range (IQR) 0 to 1 : 320, n = 29] pretreatment, to 1 : 1280 (IQR 1 : 640 to 1 : 1920, n = 15) after infusion 10, and 1 : 1920 (IQR 1 : 1280 to 1 : 2560, n = 10) after infusion 20. Infliximab-Abs were found in 21% of patients. Infliximab-Ab-positive patients and patients with LOR had significantly higher pretreatment anti-dsDNA concentrations and higher pretreatment ANA titres than infliximab-Ab-negative and responsive patients, respectively.
  
  
  CONCLUSIONS
  The results of this study suggest a role for autoantibodies in the identification of patients with psoriasis at higher risk of developing infliximab-Abs and of LOR under treatment with infliximab.
authors.affiliation: Department of Dermatology, University of Heidelberg, Voßstrasse 2, 69117 Heidelberg, Germany. jochen.hoffmann@med.uni-heidelberg.de
authors.forename: J H O
authors.initials: JH
authors.lastname: Hoffmann
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.forename: A H
authors.initials: AH
authors.lastname: Enk
authors.forename: E N
authors.initials: EN
authors.lastname: Hadaschik
mesh_terms: D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000378:metabolism*; D000911:Antibodies, Monoclonal / Q000276:immunology* / Q000627:therapeutic use; D001323:Autoantibodies / Q000378:metabolism*; D016022:Case-Control Studies; D004247:DNA / Q000276:immunology; D003879:Dermatologic Agents / Q000276:immunology* / Q000627:therapeutic use; D004351:Drug Resistance / Q000276:immunology*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000188:drug therapy / Q000276:immunology*; D012189:Retrospective Studies
chemical_list: D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D003879:Dermatologic Agents; D004247:DNA; D000069285:Infliximab