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

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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

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