Re: Treatment with TNF-alpha antagonists in patients with RA arthritis induces ACLA

[Guest guest]

,

Could you possibly offer a short translation of this article, if

possible. What are anticardiolipin antibodies, and is it good or bad

that we get them? Sue

On Tuesday, April 13, 2004, at 11:04 PM, wrote:

> Ann Rheum Dis. 2004 Apr 5 [Epub ahead of print]

>

> Treatment with TNF-{alpha} antagonists in patients with rheumatoid

> arthritis induces anticardiolipin antibodies (ACLA): ACLA predict worse

> clinical outcome with infliximab and more frequent treatment limiting

> infusion reactions.

>

> Jonsdottir T, Forslid J, Van Vollenhoven AM, Harju A, Brannemark SA,

> Klareskog L, Van Vollenhoven RF.

>

> Dept of Rheumatology, Karolinska Hospital, Stockholm, Sweden.

>

> OBJECTIVE: To determine the frequency and clinical impact of

> anticardiolipin antibodies (ACLA) in patients with rheumatoid arthritis

> (RA) treated with infliximab and etanercept. METHODS: We studied 121

> patients from the Stockholm TNF-alpha follow-up registry (STURE)

> treated

> with infliximab or etanercept. RESULTS: At baseline 13.5% of infliximab

> and 17% of etanercept treated patients had positive ACLA. After 3

> months

> the frequencies of ACLA positivity were 29% (p<0.05 compared to

> baseline) and 27% respectively and after 6 months 28% and 25%.

> Increases

> were seen for both IgG and IgM ACLA. Increasing age, a higher number of

> prior DMARDs, and higher DAS28 were predictors for development of ACLA.

> In the infliximab-treated patients, 87% of the ACLA(-) but only 50% of

> the ACLA(+) patients met the ACR20 criteria (p<0.05), and the frequency

> of treatment- limiting infusion reactions in the ACLA(+) patients was

> higher than expected (17%). ACLA positivity in the etanercept-treated

> patients did not show such a clinical correlate. Four patients had

> thromboembolic events of whom two were ACLA(+) and two ACLA(-).

>

> CONCLUSION: Frequencies of both IgM and IgG ACLA positivity increase in

> patients treated with these TNF-alphanantagonists for 3 months or

> longer. Increasing age, a greater number of prior DMARDs and a greater

> disease activity at baseline are predictors for the development of

> ACLA.

> The development of ACLA during treatment with infliximab but not

> etanercept is associated with worse clinical results and more frequent

> serious infusion reactions. ACLA are an important class of

> autoantibodies associated with TNF-alpha blocking therapy.

>

> PMID: 15066863

>

>

>

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>

>

>

>

[Guest guest]

Does it have to be short, Sue, LOL? What is the implication there?

Bottom line: Anticardiolipin antibodies aren't desirable since they are

associated with an increased risk of blood clots (thromboses).

Anticardiolipin antibodies (ACLA) are strongly associated with

antiphospholipid syndrome. These antibodies are also found in a

significant number of people with lupus.

This study implies that use of the biologics Enbrel and Remicade for

greater than 3 months, especially when other risk factors are present

(older age, greater number of DMARDs used previously, and more severe

disease at baseline), may cause the development of ACLA. These

antibodies may interfere with the effectiveness of Remicade and may

increase the rate of serious infusion reactions. Also of note is that

four subjects had thromboembolic events (though I'm not absolutely sure

that's a higher number than expected for this population - I would have

to look into this aspect further and that would require a longer answer

which I'm not sure is allowed, LOL!).

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] Treatment with TNF-alpha antagonists in

patients with RA arthritis induces ACLA

> ,

>

> Could you possibly offer a short translation of this article, if

> possible. What are anticardiolipin antibodies, and is it good or bad

> that we get them? Sue

>

> On Tuesday, April 13, 2004, at 11:04 PM, wrote:

>

> > Ann Rheum Dis. 2004 Apr 5 [Epub ahead of print]

> >

> > Treatment with TNF-{alpha} antagonists in patients with rheumatoid

> > arthritis induces anticardiolipin antibodies (ACLA): ACLA predict

worse

> > clinical outcome with infliximab and more frequent treatment

limiting

> > infusion reactions.

> >

> > Jonsdottir T, Forslid J, Van Vollenhoven AM, Harju A, Brannemark SA,

> > Klareskog L, Van Vollenhoven RF.

> >

> > Dept of Rheumatology, Karolinska Hospital, Stockholm, Sweden.

> >

> > OBJECTIVE: To determine the frequency and clinical impact of

> > anticardiolipin antibodies (ACLA) in patients with rheumatoid

arthritis

> > (RA) treated with infliximab and etanercept. METHODS: We studied 121

> > patients from the Stockholm TNF-alpha follow-up registry (STURE)

> > treated

> > with infliximab or etanercept. RESULTS: At baseline 13.5% of

infliximab

> > and 17% of etanercept treated patients had positive ACLA. After 3

> > months

> > the frequencies of ACLA positivity were 29% (p<0.05 compared to

> > baseline) and 27% respectively and after 6 months 28% and 25%.

> > Increases

> > were seen for both IgG and IgM ACLA. Increasing age, a higher number

of

> > prior DMARDs, and higher DAS28 were predictors for development of

ACLA.

> > In the infliximab-treated patients, 87% of the ACLA(-) but only 50%

of

> > the ACLA(+) patients met the ACR20 criteria (p<0.05), and the

frequency

> > of treatment- limiting infusion reactions in the ACLA(+) patients

was

> > higher than expected (17%). ACLA positivity in the

etanercept-treated

> > patients did not show such a clinical correlate. Four patients had

> > thromboembolic events of whom two were ACLA(+) and two ACLA(-).

> >

> > CONCLUSION: Frequencies of both IgM and IgG ACLA positivity increase

in

> > patients treated with these TNF-alphanantagonists for 3 months or

> > longer. Increasing age, a greater number of prior DMARDs and a

greater

> > disease activity at baseline are predictors for the development of

> > ACLA.

> > The development of ACLA during treatment with infliximab but not

> > etanercept is associated with worse clinical results and more

frequent

> > serious infusion reactions. ACLA are an important class of

> > autoantibodies associated with TNF-alpha blocking therapy.

> >

> > PMID: 15066863

[Guest guest]

, Thanks so much for the explanation. It didn't have to be short,

LOL. I just didn't want you to have to tax your brain too much. But you

have such a wonderful brain to be able to understand these technical

articles. I wonder, did you ever consider becoming a doctor? Did you

say your grandfather was one, or am I not remembering correctly?

Sue

On Friday, April 16, 2004, at 10:26 AM, wrote:

> Does it have to be short, Sue, LOL? What is the implication there?

>

> Bottom line: Anticardiolipin antibodies aren't desirable since they are

> associated with an increased risk of blood clots (thromboses).

[Guest guest]

You have an excellent memory, Sue. Yes, my grandfather was a physician.

During my grade school years I often told him I was thinking of becoming

a doctor. I had a huge crush on my ophthalmologist and thought I should

be doing eye surgery someday, too.

He recommended against it unless I had an extremely strong vocation

because he said that the profession was changing - and not in a good

way. If he were alive today, I'm sure he'd be saying, " I told you so! " I

recently learned that he also discouraged his son from going to medical

school.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

----- Original Message -----

Re: [ ] Treatment with TNF-alpha antagonists in

patients with RA arthritis induces ACLA

>

> , Thanks so much for the explanation. It didn't have to be short,

> LOL. I just didn't want you to have to tax your brain too much. But

> you

> have such a wonderful brain to be able to understand these technical

> articles. I wonder, did you ever consider becoming a doctor? Did you

> say your grandfather was one, or am I not remembering correctly?

>

> Sue