title: Possible association of etanercept, venous thrombosis, and induction of antiphospholipid syndrome.
abstract: Tumor necrosis factor α (TNF α ) inhibitors are commonly used for treatment of aggressive rheumatoid arthritis and other rheumatic diseases. Etanercept is one of the medications approved for treatment of rheumatoid arthritis. Though many studies have documented the safety and efficacy of these medications, evidence for adverse effects is emerging including cancer, infections, and cardiovascular disease. There have been studies showing that these medications induce autoantibody production, including antinuclear antibodies and anti-dsDNA antibodies. Limited data exists, however, regarding induction of antiphospholipid antibodies (APLs) by TNF α inhibitors, including anticardiolipin antibodies (ACLs), lupus anticoagulant (LAC), and anti- β 2-glycoprotein I (anti- β 2 GPI), or an association between antibody development and clinical manifestations. In this case series, we describe five patients who developed venous thromboembolism (VTE) and APLs while receiving etanercept therapy. All five of our patients met the criteria for diagnosis of APS after receiving etanercept. Our case series supports the association between etanercept, APLs, and VTE. We believe that testing for APLs prior to initiation of anti-TNF therapy is reasonable, given this relationship and the risks associated with VTE.
authors.affiliation: Internal Medicine, Michigan State University, 138 Service Road, A225 Clinical Center, East Lansing, MI 48825, USA.
authors.forename: Shanti
authors.identifier: 0000-0002-0696-5394
authors.initials: S
authors.lastname: Virupannavar
authors.affiliation: Internal Medicine and Hematology/Oncology, McLaren of Greater Lansing, 401 West Greenlawn Avenue, Lansing, MI 48910, USA.
authors.forename: Anthony
authors.identifier: 0000-0001-6672-1984
authors.initials: A
authors.lastname: Brandau
authors.affiliation: Internal Medicine and Rheumatology, Michigan State University, 138 Service Road, A225 Clinical Center, East Lansing, MI 48825, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Guggenheim
authors.affiliation: Internal Medicine, Michigan State University, 138 Service Road, A225 Clinical Center, East Lansing, MI 48825, USA.
authors.forename: Heather
authors.identifier: 0000-0001-9215-8152
authors.initials: H
authors.lastname: Laird-Fick