title: Anti-nuclear antibody positivity and the use of certolizumab in inflammatory bowel disease patients who have had arthralgias or lupus-like reactions from infliximab or adalimumab.
abstract: OBJECTIVE
  Tumor necrosis factor (TNF) inhibitors can be used to treat inflammatory bowel disease (IBD) but may lead to anti-nuclear antibody (ANA) positivity and lupus-like reactions. Because of its unique structure, certolizumab has lower rates of these complications. We sought to investigate whether patients who have had lupus-like reactions to infliximab or adalimumab would be able to tolerate certolizumab.
  
  
  METHODS
  We performed a retrospective analysis on the 23 patients at the Roberts Inflammatory Bowel Disease Center who received certolizumab for the treatment of Crohn's disease from March 2008 to June 2009. We identified 6 patients who were switched to this drug because of lupus-like reactions from prior anti-TNF therapy and had documented ANA after the reaction and prior to certolizumab initiation. We then rechecked the ANA status after certolizumab initiation.
  
  
  RESULTS
  Five out of 6 patients had a resolution of their arthralgias or lupus-like symptoms after being switched to certolizumab (P < 0.001). Of the 4 patients who were ANA positive after receiving infliximab or adalimumab, 2 became ANA negative after induction with certolizumab (P = 0.17). There was no difference in Harvey Bradshaw index scores (10.3 vs. 9.8) pre-certolizumab and post-certolizumab (P = 0.73).
  
  
  CONCLUSIONS
  Nearly all patients experienced relief from their lupus-like symptoms with certolizumab and 2 out of 4 patients reversed their ANA positivity. While future investigation is warranted, patients who have lupus-like reactions from infliximab or adalimumab may benefit from switching to certolizumab.
authors.affiliation: Department of Medicine, Weil Cornell Medical College, New York Presbyterian Hospital, New York, USA. himanshu.d.verma@gmail.com
authors.forename: Himanshu Dev
authors.initials: HD
authors.lastname: Verma
authors.forename: Ellen Janice
authors.initials: EJ
authors.lastname: Scherl
authors.forename: Vinita Elizabeth
authors.initials: VE
authors.lastname: Jacob
authors.forename: Brian Paul
authors.initials: BP
authors.lastname: Bosworth
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use*; D018771:Arthralgia / Q000139:chemically induced*; D000068582:Certolizumab Pegol; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol