title: Correlation between elevation of serum antinuclear antibody titer and decreased therapeutic efficacy in the treatment of Behçet's disease with infliximab.
abstract: BACKGROUND
  Infliximab, an anti-TNF-α monoclonal antibody, administered to Behçet's disease (BD) patients in Japan with refractory intraocular inflammation, has shown excellent clinical results. However, some patients demonstrate a decreased response to infliximab during the course of the treatment. In the present study, we investigated the correlation between this reduced therapeutic effect and elevation of the serum antinuclear antibody (ANA) titers in patients with BD who were undergoing infliximab therapy.
  
  
  METHODS
  Seventeen patients (14 males and three females) with uveitis in BD who were undergoing treatment with infliximab for 2 years or longer were enrolled. Their blood test results and clinical histories were obtained from medical records.
  
  
  RESULTS
  One patient (5.9%) was ANA-positive prior to the initiation of infliximab, and 11 patients (64.7%) developed positive ANA during the therapy. The appearance of ANA was observed 6 months after the initiation of the infliximab therapy, and its titers gradually increased. None of the patients showed lupus symptoms. Five patients (29.4%) have suffered from ocular inflammatory attacks since the sixth month from the initiation of infliximab treatment and all of them were ANA-positive. In contrast, four patients (23.5%) who were ANA-negative experienced no ocular attacks during the follow-up period.
  
  
  CONCLUSIONS
  Here we report the positive conversion and subsequent elevation of serum ANA titers in some patients with BD after the initiation of infliximab therapy. Since all recurrences of uveitis were shown only in the ANA-positive patients, serum ANA titer may be a helpful biomarker for predicting the recurrence of ocular attacks in BD patients treated with anti-TNF-α antibody therapies.
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, Japan.
authors.forename: Daiju
authors.initials: D
authors.lastname: Iwata
authors.forename: Kenichi
authors.initials: K
authors.lastname: Namba
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Mizuuchi
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kitaichi
authors.forename: Satoru
authors.initials: S
authors.lastname: Kase
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takemoto
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Ohno
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000974:Antibodies, Antinuclear / Q000097:blood*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D001528:Behcet Syndrome / Q000276:immunology* / Q000628:therapy*; D002648:Child; D004247:DNA / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D004247:DNA; D000069285:Infliximab