Long-term use of anti-TNF-alpha agents can lead to the development of autoantibodies.

Infliximab ( Remicade ) is a chimeric human-murine monoclonal antibody that inhibits TNF-alpha.

Investigators from the Department of Rheumatology, University Hospital, Umea ( Sweden ) studied the prevalence of autoantibodies in patients with rheumatoid arthritis treated with the TNF alpha inhibitor Infliximab.

A total of 53 patients, treated with Infliximab for rheumatoid arthritis, were followed for autoantibody production before treatment and after 14, 30, and 54 weeks.

Six patients treated with Etanercept ( Enbrel ) were studied for comparison.

The number of patients treated with Infliximab who developed antibodies against dsDNA of both IgG and IgM class increased significantly.
The prevalence of patients positive for IgG class increased to 66% at 30 weeks and 45% at 54 weeks, and of IgM class to 85% and 70%, respectively.

The number of patients expressing antibodies against nucleosomes and antibodies against nuclear antigens ( ANA ), also increased significantly.

The number of rheumatoid factor or anticardiolipin positive patients was stable and there was no increase in antibodies against the other antigens.

A lupus-like syndrome was seen in one patient.

No patient treated with Etanercept developed any of these autoantibodies.

This study has shown that patients treated with Infliximab may develop anti-dsDNA antibodies of both IgM and IgG class, anti-nucleosome antibodies, and antinuclear antibodies.

Source: Annals of the Rheumatic Diseases, 2005


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